Observation Of The Effect Of Sciatic Nerve Block Combined With Adductor Canal Block Under Ultrasound Guidance In Total Knee Arthroplasty

Objective:In this study,the effect of ultrasound-guided sciatic nerve block combined with adductor canal block applied in total knee arthroplasty（TKA）,and its effect on patients’perioperative analgesia and early postoperative movement.Methods:Ninety-six patients with orthopaedic knee osteoarthritis from 1 January 2021 to31 January 2022 were selected for evaluation,of whom 16 were excluded because they did not meet the entry criteria or changed their surgical plan preoperatively.The final 80 cases underwent elective total knee arthroplasty under general anaesthesia.Patients were randomly divided into 4 groups（n=20）using a random number table.group A（general anesthesia control group）,group B（general anesthesia+femoral nerve block）,group C（general anesthesia+sciatic nerve block）,group D（general anesthesia+sciatic nerve block combined with adductor canal block）.Ultrasound-guided nerve block technique was performed before general anaesthesia,and nerve block was administered with a concentration of 0.375%ropivacaine injection.After adequate preoxygenation Midazolam 0.03 mg/kg,sufentanil 0.3μg/kg and propofol 2mg/kg and rocuronium bromide 0.6 mg/kg were injected sequentially.After reaching the appropriate depth of anesthesia,the endotracheal intubation is performed,the catheter position is determined and fixed.Intraoperative pumping of Propofol and Remifentanil is administered under anesthesia.Record HR,MAP at the beginning of anesthesia（T₁）,at the time of skin cutting（T₂）,30 minutes after the start of surgery（T₃）,and before leaving the operating room（T₄）,collect 5 ml of peripheral blood before anesthesia（T₁）,before leaving the operating room（T₄）,postoperative 1d（T₅）,and postoperative 3d（T₆）patients for centrifugal preservation,and detect IL-6 and TNF-αlevels,record the rest and in moving VAS scores of patients Preoperative（H₀）、Postoperative 6h（H₆）、1d（D₁）、2d（D₂）、3d（D₃）,record and the Postoperative6h（H₆）、1d（D₁）Bromage score and occurrence of postoperative adverse reactions.Results:1.There was no statistically significant difference in the comparison of general information such as age,gender,body mass index（BMI）and length of stay between the four groups of patients（P>0.05）.2.Comparison of HR and MAP:HR comparison between four groups at T1 and T4 time points,and MAP comparison in four groups at T1 time points,the difference was not statistically significant（P>0.05）.Compared with the control group（group A）,HR and MAP were significantly lower in patients with combined peripheral nerve block（group B,C,D）,The differences were statistically significant（P<0.05）.Among them,the intraoperative HR and MAP levels in group D were more stable.3.Comparison of IL-6 and TNF-α:There was no statistically significant difference in IL-6 levels between the four groups of patients when compared at all times（P>0.05）IL-6 levels increased significantly in all groups on the first postoperative day and decreased slowly afterwards.The differences were statistically significant（P<0.05）.There was no statistically significant difference between and within the four groups of patients with TNF-α（P>0.05）.4.Comparison of rest and moving VAS scores:In the H₀time,the difference between rest and moving VAS scores was not statistically significant（P>0.05）.Compared with the control group（group A）,the rest and moving VAS scores of patients with combined peripheral nerve block（B,C,D group）were significantly lower,and the difference was statistically significant（P<0.05）.Among them,patients in group D had the lowest intraoperative rest and moving VAS scores.5.Comparison of Bromage scores at postoperative H₆and D₁:Compared with the Bromeage scores within the groups,the difference was not statistically significant（P>0.05）;Compared with group B,the Bromage score in the H₆time D group was increased;the difference was statistically significant（P<0.05）.There was no statistically significant difference in Bromeage scores between patients in D₁time groups（P<0.05）.6.Comparison of adverse reactions in each group:Comparison of the number of postoperative nausea and vomiting in patients in each group:compared with the control group（Group A）,the number of postoperative nausea and vomiting in patients with combined peripheral nerve block（Groups B,C and D）was statistically significant（P<0.05）.The difference was not statistically significant when comparing the postoperative pruritus of patients in each group（P>0.05）.There was no statistically significant difference（P>0.05）in the comparison of patients’surgical respiratory depression in each group.Conclusion:1.Ultrasound-guided sciatic nerve block combined with adductor canal block is used for TKA can maintain intraoperative blood pressure and heart rate stability in patients with TKA.Decreased significantly the postoperative VAS score and reducing the incidence of nausea and vomiting are conducive to early postoperative exercise.2.Ultrasound-guided sciatic nerve block combined with adductor canal block is used for TKA better than that of simple femoral nerve block group and simple sciatic nerve block group in TKA patients,and has more clinical application value.