Application of ultrasound-guided interspace between the popliteal artery and the capsule of the posterior knee blocks combined with saphenous nerve block and "cocktail" therapy in analgesia after total knee arthroplasty in elderly people
Wang Qian, Ling Yunzhi, Sun Yiyun, Yang Dongdong, Li Zhiyi, Gao Xingyue, Xie Yaqiong
Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
Abstract:Objective To investigate the effect of ultrasound-guided interspace between the popliteal artery and the capsule of the posterior knee (IPACK) blocks combined with saphenous nerve block and "cocktail" therapy in elderly patients undergoing total knee arthroplasty (TKA). Methods This study was a prospective study. The clinical data of 60 elderly patients undergoing unilateral TKA in the First Affiliated Hospital of Bengbu Medical College from October 2020 to September 2021 were included. There were 19 males and 41 females, aged 60-85 (69.0±6.1) years. The patients were randomly divided into three groups: group A received IPACK combined with saphenous nerve block and "cocktail" therapy, group B received sciatic nerve combined with femoral nerve and lateral femoral cutaneous nerve block, and the control group received simple general anesthesia, with 20 cases in each group. Outcome measures including: (1) baseline data such as age, gender, body mass index, and vital signs before anesthesia (mean arterial pressure [MAP], heart rate, surgical pleth index [SPI]); (2) changes of vital signs; (3) expression levels of C reactive protein (CRP) and interleukin-1β (IL-1β) before operation and 24 h after operation; (4) Numerical rating scale (NRS) pain score at 6, 12, 24, and 48 h after operation; (5) patients' first time out of bed activity time after surgery, postoperative hospital stay, and knee joint activity at 12 h, 24 h, and 48 h after operation; (6) general clinical conditions (recovery time, extubation time, dosage of remifentanil), effective pressing times of analgesic pump, recovery rate of analgesia, and incidence of related adverse reactions (nausea, vomiting, drowsiness, and bradycardia) were compared. Results (1) No significant difference was observed in baseline data among the three groups (all P values >0.05). (2) The changes of vital signs in the three groups were compared the heart rate (HR), MAP, and SPI in groups A and B were lower than those in the control group (all P values <0.05). (3) The levels of IL-1β and CRP in the control group at 24 h after surgery were higher than those in groups A and B (all P values <0.05), and no statistical significance was observed between group A and group B (all P values >0.05). (4) At 6, 12, 24, and 48 h postoperatively, the resting and exercise NRS pain scores in groups A and B were significantly lower than those in the control group, with statistical significance (all P values <0.05). (5) The range of motion of the knee joint in group A (38.4°±8.9°, 67.4°±8.2°, 82.1°±8.8°) was significantly higher than that in group B (29.5°±9.6°, 61.3°±7.1°, 72.3°±7.1°) and the control group (30.8°±6.8°, 59.9°±7.6°, 69.2°±7.4°),the differences were statistically significant (F=6.27, 5.45, 14.73, all P values <0.05). No significant difference was observed between group B and the control group (all P values >0.05). The postoperative hospital stay and the first independent ambulation time were the shortest in group A [(27±5.8) h, (3.8±0.8) days], followed by the control group [(39.6±6.4) h, (4.6±0.9) days] and group B [(47.7±4.0) h, (5.2±0.8) days]. The differences were statistically significant (F=71.33, 11.71, all P values <0.001). (6) The recovery time, extubation time, and remifentanil dosage of groups A and B were lower than those of the control group (all P values <0.05). The recovery rate of postoperative analgesia and the incidence of adverse reactions in groups A and B were lower than those in the control group (all P values >0.05). Conclusion IPACK combined with saphenous nerve block and "cocktail" therapy for elderly patients undergoing TKA surgery has good analgesic effect, short hospital stay, and small interference of motor function, which plays a positive role in early functional exercise of elderly patients with TKA.
王倩, 凌云志, 孙宜云, 杨栋栋, 李芷依, 高兴悦, 谢亚琼. 腘动脉与后膝关节囊间隙联合隐神经阻滞及“鸡尾酒”疗法在老年患者全膝关节置换术中的应用效果观察[J]. 中华解剖与临床杂志, 2022, 27(5): 324-330.
Wang Qian, Ling Yunzhi, Sun Yiyun, Yang Dongdong, Li Zhiyi, Gao Xingyue, Xie Yaqiong. Application of ultrasound-guided interspace between the popliteal artery and the capsule of the posterior knee blocks combined with saphenous nerve block and "cocktail" therapy in analgesia after total knee arthroplasty in elderly people. Chinese Journal of Anatomy and Clinics, 2022, 27(5): 324-330.
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