The Effect Of Different Analgesia Methods On The Level Of Plasma Th1/Th2 In Patients Under Total Knee Arthroplasty

Objective: This study planned to compare the effects of continuous femoral nerve block analgesia and patient controlled intravenous analgesia on Th1/Th2 in patients undergoing total knee arthroplasty(TKA).The main aim of the study was to explore the best analgesia method to decrease postoperative immune response and improve outcome.Methods: Thirty patients undergoing unilateral total knee Arthroplasty were included.All patients met the American Society of Anesthesiologists(ASA)physical status I–II.They were equally randomized to receive continuous femoral nerve block analgesia(cFNB,Group C)or receive patient-controlled intravenous analgesia(PCIA,Group P).Both groups received general anesthesia with laryngeal mask airway.The combined of intravenous and inhalation anesthesia was used during the operation,and the laryngeal mask was removed within 5-10 min after the operation.In Group C,cFNB was completed by ultrasound-guided after induction and gave a loading dose of 0.375% ropivacaine 20 ml.The electronic controlled analgesia pump with 0.2% ropivacaine 240 ml total was connected after the surgery.The pump was included background dose 5 ml/h,bolus dose 5 ml and lock time 30 min.Its continuous infusion was 48 h.In Group P,when skin closure we gave loading dose of fentanyl 0.05 mg,PCIA pump was connected after the surgery with fentanyl 20 ug/kg total.The pump was included background dose 2 ml/h,bolus dose 2 ml and lock time 15 min.The venous blood samples were taken for measuring the level of plasma Th1 and Th2 before the operation(T0),1 h(T1),24 h(T2)and 48 h(T3)after the surgery.At the same time,the blood pressure and heart rate were also recorded.The sedation scores,resting and active and passive flexion extension activities of VAS pain scores,postoperative adverse complications and patient satisfaction were also compared.All data were analyzed by software Stata12.0,the differences were significant when P < 0.05.Results: Finally,twenty-eight patients completed this study.The results showed us the blood pressure and heart rate had no significant differences between two groups.And also,there were no differences to compare the inter statistics of T1、T2、T3 with T0(P > 0.05).It was almost meaningless to compare the differences of Ramsay sedation markings of the two groups after the operation(P > 0.05).Also,there was no meaning between two groups in VAS pain scores at T1 when patients do not moved(P > 0.05),but VAS scores of group C were lower than group P at T2、T3(P < 0.05).Moreover,the movement VAS scores of group C were obviously lower than group P after the operation(P < 0.05).In Group P,the adverse reaction and additional postoperative analgesics was significantly higher than Group C(P < 0.05).Patient satisfaction with the performance of Group C was significantly higher than Group P(P < 0.05).The Th1%,Th2% and Th1/Th2 at T0,T1 and T2 produced no statistically significances(P > 0.05),but the percent ages at T3 in Group P were less than in Group C(P < 0.05).In Group P,the Th1%,Th2% and Th1/Th2 were lower at T3 than at T0(P < 0.05),while the percent ages had no significant differences at T0,T1 and T2(P > 0.05).In Group C,the Th1%,Th2% and Th1/Th2 had no statistically significances at all points(P > 0.05).Conclusion: The cFNB has been shown to more suitably to maintain Th1/Th2 balance than PCIA in total knee arthroplasty;It is an ideal analgesia method for decreasing postoperative immune response and improving patients′ outcome.