Effects Of Postoperative Analgesia With Fascia Iliaca Compartment Block And Adductor Canal Block Combined With Dexmedetomidine On Patients Recovery And Sleep After Total Knee Arthroplasty

Objective: To explore the effects of fascia iliaca compartment block(FICB)and adductor canal block(ACB)in combination with dexmedetomidine on postoperative rehabilitation and sleep of patients undergoing total knee arthroplasty after subarachnoid anesthesia.Methods:1.Stage Ⅰ: Sufferers were stochastically separated into two groups,the control group(C1 group)and FICB combined with ACB group(D1 group)according to the random number table.Both groups of suferers received subarachnoid block anesthesia.Routine opioid automatic analgesia was given to group C1 after operation.Group D1 was treated with FICB and ACB without any other postoperative analgesia treatment.Blood pressure and heart rate changes were recorded before(T0),30min(T1),60min(T2),and 10min(T3)after tourniquet release.VAS scores(6h,24 h,48h)were recorded.Ramsay sedation score(24h,48h)was recorded,and Alsens Insomnia Scale(postoperative day 2 and postoperative day 3)was filled out.The incidence of postoperative nausea,vomiting,headache,drowsiness and bradycardia was recorded.Dosage of pethidine,changes in C-reactive protein(preoperative day,postoperative day)and patient satisfaction were recorded.2.Stage Ⅱ: Sufferers were stochastically separated into two groups,the FICB and ACB group(C2 group)and FICB combined with ACB combined with dexmedetomidine group(D2 group)according to the random number table.Two groups of sufferers were treated with FICB and ACB after subarachnoid block.Group C2 was not treated with any postoperative analgesic device,and group D2 was treated with self-controlled analgesic device only 300μg dexmedetomidine after surgery.VAS scores(6h,24 h,48h)were recorded.Ramsay sedation score(24h,48h)was recorded,and the Alsense Insomnia Scale(2nd day after operation and 3rd day after operation)was filled in.Morbidity of postoperative nausea,vomiting,headache,drowsyness and bradycardia recorded Dosage of pethidine,changes in C-reactive protein(preoperative day,postoperative day)and patient satisfaction were recorded.Results:1.Stage Ⅰ: Compared with the control group(C1),the VAS scores of the FICB combined with ACB group(D1 group)at 6h(T4),rest and exercise pain was lower at24 hours(T5)and 48h(T6)(P<0.05),while Ramsay sediment scores were higher at 24 hours and 48 h low(P<0.05).Postoperative c reactive protein,AIS score(on the day of operation and day after operation)was low(P<0.05),postoperative nausea and vomiting(P<0.05)were low,pethidine dose was low within 24 hours,and satisfaction score was high(P<0.05).However,there was no significant difference between blood pressure and heart rate(T0-T3),the morbidity of dizziness and bradycardia,the dosage of pethidine for 24-48 h,and the proportion of satisfied patients compared to the C1 group and D1 group.(P > 0.05).2.Stage Ⅱ: Compared with the FICB and ACB group(C2 group),the VAS scores of the FICB combined with ACB group combine with dexmedetomidine group(D2group)at 6h(T4),24-hour rest and exercise pain(T5)and 48h(T6)were lower(P<0.05).Ramsay sediment score was higher at 24 hours and 48h(P<0.05).The Postoperative C-reactive protein was lower(P<0.05),and sleep scores on surgical days and the day after surgery was lower(P<0.05),while satisfaction scores was higher(P<0.05).However,when compared with the C2 group and D2 group,no significant difference was shown in blood pressure and heart rate(T0-T3),incidence of dizziness,nausea and vomiting,bradycardia,dosage of pethidine within 24 h and 24-48 h,and percentage of satisfactory(P > 0.05).Conclusion:1.The fascia iliaca compartment block combined with adductor canal block can be reduced valid in the level of after technique ache in patients with TKA and also,can be effectively reduced the use level of early opium kind medicine.2.The fascia iliaca compartment block combined with adductor canal block can increase sleeping quality,and also,the occurence rate of postoperative nausea and vomiting and inhibit inflammation can be effectively reduced,as well as promote the recovery of patients.3.The fascia iliaca compartment block combined with adductor canal block combined with dexmedetomidine effectively reduced postoperative pain and enhanced sedation in patients with TKA.4.The fascia iliaca compartment block combined with adductor canal block combined with dexmedetomidine can inhibit postoperative inflammatory reaction,significantly improve postoperative sleep quality and improve patient comfort.