| Objective: Total knee arthroplasty(TKA)is an important surgical approach for the correction of degenerative joint diseases.However,postoperative sharp pain inhibits the early functional training of patients.Effective postoperative analgesic management is critical for shortening rehabilitation time,improving motor function of joints,and promoting life quality of patients.Analgesic methods such as peripheral nerves blocks,epidural analgesia and local incision infiltration analgesia(LIA)have been widely used in clinical practice,in which ultrasound-guided adductor canal blockade(ACB)has great advantages in inducing an analgesic effect,and reducing complications such as nerve injury and low muscle strength.The study aims to evaluate the application value of ultrasound-guided ACB in perioperative multimodal analgesia in TKA,in the hope to provide reference basis for pain management and functional training after TKA.Methods: A total of 80 patients who received TKA in our hospital from January 2015 to August 2016 were selected for this study.All patients received TKA for the first time in the unilateral side.They were randomly divided into two groups using a random number table(each group has 40 patients): control group and observation group.Both groups received LIA.On this basis,patients in the control group were added with ultrasound-guided femoral nerve blockade(FNB),while patients in the observation group were added with ultrasound-guided ACB.Rest pain and motion pain scores were evaluated using the Numerical Pain Rating Scale(NPRS)and compared between the two groups at pre-operation and at 6,12,24 and 48 hours post-operation.The myodynamia of quadriceps femoris was compared between the two groups at 24 and 48 hours post-operation.The active flexion and extension angles of the knees,the added dosage of analgesics,and walking distance were compared at postoperative day one and two.Furthermore,the postoperative average duration of hospital stay and rates of anesthesia-associated adverse reactions were also compared.Patients were followed up for one month,and the occurrence rate of falling down was compared.Results(1)Rest pain and motion pain scores evidently decreased in both groups after the operation(P<0.05).However,there was an insignificant comparison difference of timing between these two groups(P>0.05).(2)The myodynamia of quadriceps femoris of patients in the observation group was notably larger than that in the control group at 24 and 48 hours after the operation,and the difference is statistically significant(P<0.05).However,the myodynamia of quadriceps femoris in the observation group between 24 and 48 hours has no difference(P>0.05),while that in the control group was markedly less after 48 hours than after 24 hours,and the difference is statistically significant(P<0.05).(3)In both groups,the active knee flexion angle increased on postoperative day two,compared to that on day one(P<0.05),and that was notably larger on both day one and two in the observation group,than in the control group;the difference is statistically significant(P<0.05).However,these two groups have no differences in extension angle(P>0.05).(4)In both groups,the added dose of analgesics evidently decreased on postoperative day two compared to that on postoperative day one(P<0.05),but that on postoperative day one and two has no difference between these two groups(P>0.05).(5)In both groups,walking distance increased on postoperative day two,compared to that on day one(P<0.05),but that on postoperative day one and two has no difference between these two groups(P>0.05).(6)The postoperative average duration of hospital stay was prominently shorter in the observation group than in the control group(P<0.05),but the occurrence rates of anesthesia-associated adverse reactions and falling down between these two groups have no differences(P>0.05).Conclusion: Both ultrasound-guided FNB and ACB have excellent efficacy in post-TKA pain management,in which ACB is superior in improving myodynamia and motor function of joints. |
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