Controlling pain in total knee arthroplasty：three-stage cocktail periarticular injection verus femoral nerve block

KONG Xiang-peng; REN Peng; NI Ming; LI Xiang; CHEN Ji-ying; CHAI Wei

doi:10.3969/j.issn.2095-252X.2016.10.008

Abstract：Objective To compare the analgesia effects of 3-stage cocktail periarticular injection verus femoral nerve block in the treatment of total knee arthroplasty ( TKA ).Methods From February 2016 to June 2016, 60 patients who underwent unilateral TKA were enrolled in the study. There were 25 men and 35 women, whose average age was 63 years old ( range: 54 - 73 years ). All the patients were divided into 2 groups. In cocktail group, 30 patients were treated with general anesthesia and 3-stage cocktail periarticular injection. In nerve block group, 30 patients were treated with femoral nerve block anesthesia and catheter. There were no statistically significant differences between the 2 groups in the age, sex ratio, body mass index ( BMI ), operation method and type of knee prosthesis. All the patients received the same medication at 24 h before the operation, including tramadol ( 100 mg ), celecoxib ( 200 mg ) and ondansetron ( 4 mg ). The patients in cocktail group received 1% ropivacaine ( 200 mg ), morphine ( 5 mg ), epinephrine ( 10 drops, about 0.25 ml ) and tranexamic acid ( 100 ml ), which were injected into the knee before the operation, after osteotomy and after prosthesis installation. No intraoperative injection of cocktail was noticed during the operation in the patients in nerve block group, who received femoral nerve catheter after the operation. And the femoral nerve catheter was pulled out at 24 h after the operation. After the operation, the patientsin both groups received parecoxib sodium ( 40 mg, twice a day ), tramadol ( 100 mg, twice a day ) and pregabalin ( 75 mg, twice a day ). And 48 h later, they received celecoxib ( 200 mg, twice a day ) instead of parecoxib sodium. When acute pain occurred, oxycodone-acetaminophen ( 5 mg / 325 mg ) was given. The visual analogue scale ( VAS ) scores ( 1 - 10 points ), operating time, knee range of motion after hospital discharge and length of hospital stay were recorded within 72 h after the operation. Statistical analysis was conducted by using the t-test andχ2-test.Results All the patients were followed up and their data were recorded. The VAS scores were ( 3.3 ± 1.1 ) points and ( 4.2 ± 1.6 ) points at 24 h after the operation in cocktail group and nerve block group respectively. The differences between them were statistically signiifcant (P < 0.05 ). The length of hospital stay was ( 8.0 ± 3.3 ) days in cocktail group, which was ( 8.6 ± 4.3 ) days in nerve block group. The differences between them were statistically signiifcant (P < 0.05 ). There were no statistically signiifcant differences in operating time and range of motion between the 2 groups.Conclusions General anesthesia combined with 3-stage cocktail periarticular injection can control pain better than femoral nerve block in the treatment of TKA, as well as shorten hospitalization time, achieve satisfactory range of motion after hospital discharge but not prolong operating time.