Saphenous Nerve Block Combined With "Cocktail" Therapy Clinical Observation For Total Knee Arthroplasty

Objective: To observe the clinical effect of saphenous nerve block(SNB)combined with "cocktail" therapy on postoperative pain and functional recovery of knee joint in patients with total knee arthroplasty(TKA)and to explore a more applicable postoperative analgesia pattern for TKA patients.Methods: In this study,conducted from October 2019 to October 2020,a total of 94 patients of the Department of Arthritis Surgery of our hospital who underwent unilateral TKA were divided randomly into observation groups(group A)and control groups(group B)according to the random data table method.The patients of group A underwent general anesthesia combined with SNB and periarticular injection of a mixture of ropivacaine and betamethasone.The patients of group B received general anesthesia combined with SNB and periarticular injection of an equal dose of 0.9% normal saline.Finally,85 patients were included in the statistical analysis.There were 43 patients in group A and 42 patients in group B.The knee resting、active visual analogue scale(VAS)scores at different time points within 72 h after surgery was observed and recorded in both groups.When the VAS score was ≥4 points,flurbiprofen axetil was used as the first analgesic remedy and tramadol as the second analgesic remedy.The dose of analgesic drugs used in the two groups was recorded respectively.The range of knee joint motion and muscle strength of quadriceps of affected limbs were observed and recorded in both groups within 7d.The incidence of adverse complications such as local anesthetic intoxication,nerve injury and others in 3d after operation were also recorded.The postoperative length of stay and satisfaction of patients between the two groups were compared.Results: Compared with gender,age,course of disease,and American Society of Anesthesiologists(ASA)grade between the two groups,there were no statistically significant differences(P>0.05).It is comparable and can be used for controlled clinical studies.In terms of postoperative VAS score,every observation time point during 48 h after surgery,the resting or active VAS score of knee joint in group A was lower than that in group B(P<0.05).At 72 h after surgery,there was no significant difference between the two groups(P>0.05).The postoperative range of knee joint motion was measured and compared in both groups.At every observation time point during 48 h after surgery,the performance of group A was better than that of group B(P<0.05).Still,there was no significant difference in either on postoperative 3d,5d and 7d(P > 0.05).There was no significant difference in the muscle strength of quadriceps of an affected limb at each observation time point during 72 h after surgery between two groups(P > 0.05).Within three days after the operation,three cases of vomiting and one case of dizziness occurred in group A,three cases of dizziness and two cases of vomiting in group B.NO adverse reactions such as hypotension were observed.Regardless of the dosage of remedial analgesics,the length of hospital stay or patient satisfaction,the patients of group A were still better than those of group B patients(P<0.05).Conclusion: Compared with SNB alone,the multimodal analgesia of SNB combined with "cocktail" therapy was significantly more effective in alleviating pain in the early stage after TKA.Not only is it capable of improving range of knee joint motion in the early stage safely and effectively,but also improving the overall efficacy of TKA and patient satisfaction further.