Application Of Ultrasound-guided Femoral Nerve Block Combined With Sciatic Nerve Block For Analgesia After Total Knee Arthroplasty

Objective To explore the effect of ultrasound-guided femoral nerve block combined with sciatic nerve block for analgesia after total knee arthroplasty.Methods A total of 120 patients who underwent total knee replacement surgery were selected as the research subjects.The research subjects were from the patients admitted to our hospital from May 2019 to February 2021.Through random sampling,the study subjects were divided into 4groups,namely group A,group B,group C,and group D.The number of patients in each group was30.Among them,group A(general anesthesia group),group B(general anesthesia combined with0.5% ropivacaine 20 ml femoral nerve block group),group C(general anesthesia combined with0.5% ropivacaine 20 ml sciatic nerve block group),D Group(Patients were treated with general anesthesia,20 ml of ropivacaine was used to block the femoral nerve;at the same time,20 ml of ropivacaine was used to block the sciatic nerve.The concentration of ropivacaine was 0.5%).After the operation,the four groups were all connected to a disposable PCIA(Patient controlled intravenous analgesia)pump(sufentanil,dose 100ug;azasetron,dose 10mg),input dose: 2ml/h,single additional dose: 0.5ml,Locking time: 15 min.After medication,the visual analog scale(VAS)of the four groups of patients was evaluated,and the evaluation time was 2h,6h,12 h,24h,and 36 h after the operation.Other evaluation indicators include the AKS(American knee society)knee score at 3 days postoperatively,the first intravenous patient-controlled analgesia pump compression time and the total effective number of postoperative intravenous patient-controlled analgesia pump compressions,the time when the subjects first went to the ground after surgery,and the patient’s adverse reactions to anesthesia(including nausea,vomiting,headache,hypotension,and respiratory depression).Results(1)The postoperative VAS scores of the four groups of patients were statistically compared:group B and group C scored basically the same at the same time,and the results were not statistically significant(P > 0.05).At 2h,6h,and 12 h after surgery,the difference between each group The comparison result of the mean of VAS scores is group A > group B & C > group D,which is also statistically significant(P < 0.05).For the two time nodes of 24 h and 36 h,the difference in the scores of the four groups is not obvious.The comparison results There was no statistical significance(P >0.05).(2)Statistically compare the AKS scores of the four groups of patients at 3 days postoperatively: the mean scores of the two groups of patients in group B and C are not significantly different,and there is no statistically significant difference in the mean between the groups(P > 0.05);AKS score The order of the mean from high to low is group D > group B & C > group A.(3)Statistical comparison of the first intravenous self-controlled analgesia pump compression time of the four groups of patients,and the overall effective number of postoperative patient-controlled analgesia pump compressions: There is no significant difference between the data of the two groups of patients in group B and group C,and the difference is not statistically significant(P > 0.05);the first time for the first intravenous self-controlled analgesia pump compression is group D > group B & C > group A from long to short,and it is statistically significant(P < 0.05).The overall effective patient-controlled analgesia pump compressions were ranked in order from most to least to group A> group B & C > group D,which was statistically significant(P < 0.05).(4)Comparison of the first landing time of the four groups of patients: the average landing time of group A was longer than that of the B & C group,but it was not statistically significant;the landing time of group D was shorter than that of the other groups,and it was statistically significant(P < 0.05).(5)Statistically compare the adverse reactions of anesthesia(nausea and vomiting,headache,hypotension,respiratory depression,etc.)of the four groups of patients: the probability of nausea and vomiting in group A was significantly higher than that in other groups,with statistical significance(P< 0.05).The probability of headache in group A was higher(10%),and the chi-square test was performed on the results.The results showed that the differences between the groups were not statistically significant(P > 0.05).For the statistics of hypotension,the results showed that the difference between the groups was not statistically significant(P > 0.05).None of the study subjects experienced respiratory depression.Conclusion Ultrasound-guided femoral nerve block combined with sciatic nerve block can improve the analgesic effect after total knee arthroplasty,the total knee joint function is significantly improved,the first time to go to the ground after surgery is shortened,and patient satisfaction was higher.