| Objective:Postoperative pain is the main reason that affects early rehabilitation after total knee arthroplasty(TKA).Especially for elderly patients,acute pain may also cause a series of serious complications during the perioperative period,directly affecting the enhanced recovery of elderly patients after surgery.This article mainly discusses the effect of multimodal analgesia involving continuous adductor canal saphenous nerve block on the enhanced recovery of elderly patients after TKA through a randomized controlled study.Method:With the approval of the hospital ethics committee,50 elderly patients with unilateral knee arthroplasty from March 2020 to November 2020 were selected,ASA anesthesia grade I-III.They were grouped by random number table and divided into continuous adductor canal saphenous nerve block multimodal analgesia group(observation group)and patient-controlled intravenous multimodal analgesia group(control group),25 cases in each group.All patients were included in the enhanced recovery mode,and celecoxib was taken orally for preemptive analgesia 2 days before the operation.The basic cognitive status of all patients was evaluated by a simple mental state examination scale(MMSE)1 d before operation.The observation group underwent ultrasound-guided saphenous nerve block in the adductor canal,a single dose of 0.375% ropivacaine 20 ml,and indwelling nerve block trocar.After determining the effect plane,connect an analgesic pump for continuous infusion of 0.2% ropivacaine,combine general anesthesia.The control group received simple general anesthesia and patient-controlled intravenous analgesia after the operation.The knee joint capsule "cocktail" block was performed by the surgeon during the operation.Record and compare the duration of anesthesia,intraoperative blood loss,intraoperative rehydration volume,opioid anesthetic remifentanil usage,static and dynamic VAS scores when the patients left the room(0h)and at 6h,24 h,48h after surgery,the time of the first activity,knee range of motion and HSS score of knee joint 3 days after operation,perioperative complications(nausea,vomiting,postoperative delirium),additional rescue analgesics and the length of hospital stay.Results:There was no significant difference in general condition,MMSE score,anesthesia duration,intraoperative blood loss and rehydration volume between the two groups(P >0.05).Compared with the control group,the use of remifentanil in the observation group was significantly reduced(P <0.05).There was no significant difference between the two groups in the static VAS scores at 0h,6h,24 h,48h after the operation and there was no significant difference in the dynamic VAS scores at 0h,6h after the operation(P >0.05).The dynamic VAS scores at 24 h and 48 h after operation in the observation group were lower than that in the control group(P <0.05).There were significant differences in the time of the first activity,the range of motion of the knee joint and the HSS score of the knee joint 3 days after the operation between the two groups(P <0.05).There was no difference in the number of additional rescue analgesics between the two groups(P > 0.05).The perioperative complications(nausea,vomiting)and the length of hospital stay in the observation group were less than those in the control group(P <0.05),there was no postoperative delirium in either group.Conclusion:Preoperative ultrasound-guided continuous adductor canal saphenous nerve block in multimodal analgesia can reduce the use of anesthetic opioids during surgery and have satisfactory dynamic analgesic effects after surgery.It can promote and benefit the elderly patients to get out of bed early and function exercise after joint replacement,reduce perioperative complications and the length hospital stay,which is beneficial to the enhanced recovery of elderly patients after total knee replacement. |
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