Comparative Study On The Efficacy Of Single-shot Femoral Nerve Blockade Or Local Infiltration Analgesia In Total Knee Arthroplasty

Objective By comparing the efficacy and impact between two kinds of multimodalanalgesia: composed of either single-shot femoral nerve blockade or local infiltrationanalgesia combined with pre-and postoperative oral non-steroidal anti-inflammatorydrugs and postoperative cold therapy in total knee arthroplasty，to find a betteranesthetic scheme.Methods From February2012to June2013,75patients undergoing initial unilateraltotal knee arthroplasty (TKA) who were registered in our department withosteoarthritis of the knee (OA) were collected,including male27cases, female48caseswho were all postmenopausal, in the53-81age distribution. All the patients wereconsistent with the operative indications and no surgery contraindication. With theprospective, randomized and comparative methods, they were divided into single-shotfemoral nerve blockade group (group F), local infiltration analgesia group (group L)and intravenous analgesia pump group (group I)，25cases each group. The methods ofanesthesia are all intravenous and inhalation general anesthesia. Methods of analgesia:Group F: pre-and postoperative oral celecoxib capsules and tramadol extended releasetablets plus single-shot femoral nerve blockade after anesthesia plus postoperative coldtheropy; Group L: preo-and postoperative oral celecoxib capsules and tramadolextended release tablets plus intraoperative local infiltration analgesia pluspostoperative cold theropy; Group I: no preoperative analgesia, use postoperativeintravenous analgesia pump. Recorded and compared with postoperative VAS pain scores of knee, additional amount of morphine, time of active straight leg raising to45°, time of active flexion to90°, range of motion (ROM) of knee at discharge,incidence of postoperative respiratory depression, vomiting, urinary retention in thethree groups of patients.Result1.Compared with group F, patients in group L had no significant difference inthe VAS pain scores of knee, additional amount of morphine, time of active straight legraising to45°, time of active flexion to90°, range of motion of knee at discharge(P>0.05), and the incidence of postoperative vomiting and urinary retention weresimilar (P>0.05). In addition, patients in both groups had no respiratory depression.2.Compared with group I, group F and group L had lower consumption of morphine,VAS pain scores in the first three days, time of active straight leg raising to45°, timeof active flexion to90°, incidence of postoperative respiratory depression, urinaryretention, vomiting (P<0.05) and larger ROM of knee at discharge (P<0.05), which allhad statistically significant differences. However, in the4to5days, there were nostatistically significant differences in VAS pain scores.Conclusion1.Single-shot femoral nerve blockade and local infiltration analgesia havesimilar analgesic efficacy without significant complications.2.Either single-shotfemoral nerve blockade with ropivacaine and epinephrine plus pre-and postoperativeoral celecoxib capsules and tramadol extended release tablets plus postoperative coldtheropy or preo-and postoperative oral celecoxib capsules and tramadol extendedrelease tablets plus intra-operative local infiltration analgesia plus postoperative coldtheropy, both multimodal preemptive analgesia protocols could provide betteranalgesic efficacy than intravenous analgesia pump, reduce morphine consupmtion andthe occurrence of related complications, promote earlier functional exercises, andaccelerate the recovery of joint function.