Objective To evaluate the analgesic effect of ultrasound-guided genicular nerve block(GNB)and local in-filtration analgesia(LIA)after total knee arthroplasty(TKA).Methods A total of 60 patients undergoing unilateral TKA under general anesthesia were randomsied into LIA and GNB groups,with 30 patients in each group.After induc-tion of general anesthesia,the GNB group underwent ultrasound-guided GNB(20 mL of 0.2%ropivacaine)while the LIA group received periarticular LIA(100 mL of 0.2%ropivacaine)before the end of surgery.The primary outcome was the numerical rating scale(NRS)score at rest at 24 h postoperatively.Secondary outcomes included the NRS scores at rest(6,48 h)and during movement(6,24,48 h),sufentanil consumption at 24 h and 48 h,20 m walk test times at 24 h,nausea and vomiting at 48 h postoperatively,patient satisfaction and hospital stay.Results Compared to the LIA group,patients in the GNB group had significantly lower NRS scores at rest(3.6±1.0 vs.2.4±0.8,P<0.001)and during movement(5.4±1.4vs.3.9±1.1,P<0.001)at24hpostoperatively andat rest(4.2±1.2vs.3.4±0.9,P=0.010)and during movement(5.7±1.4 vs.4.4±1.2,P<0.001)at 48 h postoperatively.Sufentanil consumption in the GNB group was significantly lower than in the LIA group at both 24 h[(56.9(49.2-62.4)vs.43.1(38.5-48.1),P<0.001]and 48 h[90.4(85.1-105.5)vs.81.7(75.9-90.6),P=0.002]postoperatively.The two groups showed no significant difference in NRS score at 6 h postoperatively,nausea and vomiting within 48 h,20 m walk test times at 24 h,satisfac-tion scores and hospital stay(P>0.05).Conclusion Compared with LIA,ultrasound-guided GNB can significantly reduce pain scores and opioid consumption at 24 and 48 h postoperatively in TKA patients.
关键词
全膝关节置换/局部浸润镇痛/膝神经阻滞/加速康复/术后疼痛
Key words
Total knee arthroplasty/Local infiltration analgesia/Genicular nerve block/Enhanced recovery after surgery/Postoperative pain
维普
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