Comparative Study Of Clinical Efficacy Of Nerve Block And Local Infiltration In Postoperative Analgesia After Total Knee Arthroplasty

Objective:To compare the effects of femoral nerve combined with sciatic nerve block analgesia and local infiltration analgesia(LIA)on acute pain,knee range of motion,postoperative function and adverse reactions after total knee arthroplasty(TKA),and to explore whether these two analgesia methods have differences in the level of inflammatory mediator C-reactive protein(CRP).Methods:From January 2021 to September 2022,a total of 100 patients who met the inclusion criteria and exclusion criteria were randomly divided into nerve block(NB)group and LIA group,with 50 patients in each group.The NB group was given femoral nerve block(FNB)combined with sciatic nerve block(SNB).To compare the rest and exercise Numerical Rating Scale(NRS)scores and the length of time with a score less than 3 at postoperative hours 2,4,6,8,10,12,day 1,day 2,and day 3 in the two groups,knee range of motion on postoperative days 1,2,and 3,CRP on postoperative days 1and 3,the time required to complete the TUG(timed up-and-go,TUG)test on postoperative day 3,the patient’s HSS(Hospital for Special Surgery Rating scale,HSS)score at postoperative week 6,and the occurrence of adverse reactions of patients after operation were also compared.Results:All patients were fully enrolled in this study.Patients in NB group had lower rest and exercise NRS scores than LIA group on postoperative hours 2,4,6,8,10,12,and day 1,with statistically significant differences between the two groups(P<0.05);The mean duration of postoperative NRS score <3was 16.02 ± 2.57 h in NB group and 6.85 ± 1.85 h in LIA group,with a statistically significant difference between the two groups(P<0.05);The mean knee flexion angle was 59.10 ± 10.37° and 50.34 ± 8.33° in NB and LIA groups,respectively,on postoperative day 1,with statistically significant differences between the two groups(P<0.05).There was no statistically significant difference in rest and exercise NRS scores and knee flexion angle between the two groups on postoperative day 2 and day 3(P>0.05);There was no statistically significant difference between the two groups in terms of knee extension angle,CRP,TUG test,HSS score and incidence of adverse events after surgery(P>0.05).Conclusions:1.Both femoral nerve combined with sciatic nerve block and local infiltration analgesia can reduce the pain after TKA,but there is no significant difference in CRP level;2.Compared with local infiltration analgesia,the analgesic effect of femoral nerve combined with sciatic nerve block is better and lasts longer,the angle of knee flexion is larger at early stage,and the incidence of postoperative adverse reactions is not increased;3.Although femoral nerve combined with sciatic nerve block analgesia has shown advantages in pain control and knee flexion angle,it is not enough to produce obvious additional functional benefits in the early stage,and whether it can bring additional benefits in the medium and long term still needs further study.