Effect Of Fascia Iliaca Compartment Block On Perioperative Pain In Elderly Patients Undergoing Total Knee Arthroplasty

Objective The effects of preoperative and postoperative fascia iliaca compartment block on perioperative pain in elderly patients with unilateral total knee replacement were observed.Method The forty-six cases of elderly patients who were 65-75 years old were be selected with total knee replacement,the American society of anesthesiologists(ASA)class level Ⅱ to level Ⅲ,by using the method to random Numbers are divided into A,B two groups.Group A,preoperative group:patients with ipsilateral fascial space block under ultrasound before surgery;group B,postoperative group:patients with iliac fascial space block under ultrasound before patients waking.The drug concentration of sacroiliac fascial block is 0.33%ropivacaine in a dose of 30 ml.Both groups of patients underwent general anesthesia with venous and laryngeal masks.Analgesics(fentanyl)were added during the operation according to the depth of anesthesia and hemodynamic monitoring.After the operation,the patient’s intravenously controlled PCIA analgesic pump was used.The analgesic pump formula and operating parameters are consistent.Observe and record the MBP,HR,SPO2 and other indicators before anesthesia(T0),5min after tracheal intubation(T1),5min after the start of surgery(T2),1h after the start of surgery(T3),and at the end of the operation(T4).The intraoperative analgesic dosage(fentanyl)and the VAS pain scores of patients at 2h,6h,12h,and 24h were recorded,and the number of PCA and total PCA dosage within 24h were recorded.Collect 3ml of peripheral venous blood samples(ethylenediaminetetraacetic acid anticoagulant)from patients at T0,T2,T3,and T4,and centrifuge at 4000rpm.The supernatant was stored in EP tube at-80℃ and stored in batches to be tested.The catecholamines(serum cortisol,epinephrine,norepinephrine,ACTH concentration)were detected by enzyme-linked immunosorbent assay ELISA,and the values at corresponding time points were recorded.Results(1)There were no significant differences in VAS pain scores and FAS pain scores within 24 hours after surgery in the two groups,and there were no significant differences in the number and amount of additional analgesia pumps(P>0.05),and the patients had postoperative complications and analgesia.The pump-related complications and other related indicators were not statistically significant(P>0.05);(2)the serum cortisol,epinephrine,norepinephrine,and adrenocorticotropic hormone concentrations in group A at time points T2 and T3 Group B was low(P<0.05);(3)Compared with group B,patients in group A had lower MBP,HR and fentanyl doses at T3,and they were statistically significant(P<0.05).Conclusion This clinical research observation found that,for elderly patients who underwent unilateral total knee arthroplasty under total intravenous anesthesia,(1)compared with postoperative FICB on the ipsilateral side,using the same intravenous analgesia pump,no significant improvement was found in postoperative analgesia in patients undergoing nerve block.There were no significant differences in pain scores,number of additional analgesic pumps,and dosage of analgesic pump drugs,and there was no significant difference in the incidence of postoperative complications,(2)preoperative nerve block can also reduce the pain caused by surgical trauma and tourniquet And stress response.