Clinical efficacy of ultrasound-guided adductor block with chloroprocaine combined with fentanyl for early rehabilitation training after total knee arthroplasty / 中国基层医药

ABSTRACT

Objective:To investigate the effects of ultrasound-guided adductor block with chloroprocaine combined with fentanyl on analgesia and early rehabilitation after total knee arthroplasty.Methods:Eighty-eight patients who underwent total knee arthroplasty in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between June 2018 and June 2020 were included in this study. They were randomly divided into control and study groups, with 44 patients per group. The control group was subjected to distal adductor block with ropivacaine. The study group received distal adductor block with ropivacaine combined with fentanyl. Before and after distal adductor block, resting pain response was evaluated using the Visual Analogue Scale. The success rate, onset time of block, and duration of block effect were recorded. The quadriceps femoris muscle strength, knee joint range of motion, and Hospital for Special Surgery knee score before and after block were measured. The time spent in stand-to-walk test and 10-meter walking test, and incidence of falls during rehabilitation training as well as drug-related adverse reactions were recorded.Results:There were no significant differences in resting-state and task-state Visual Analogue Scale scores post-block between the two groups ( t = 0.43, 0.46, P = 0.689, 0.644). The onset time of block and duration of block effect in the study group were (5.02 ± 0.94) minutes and (2.64 ± 0.39) minutes, respectively, which were significantly shorter than those in the control group [(7.49 ± 1.12) minutes, (7.08 ± 0.92) minutes, t = 5.73, 13.02, both P < 0.001]. There was no significant difference in block success rate between study and control groups (100.0% vs. 100.0%, χ 2 = 0.00, P = 1.000). The quadriceps femoris muscle strength, knee range of motion, and Hospital for Special Surgery knee score in the study group were (4.68 ± 0.44), (112.57 ± 9.96) o and (70.56 ± 6.84) points, which were superior to those in the control group [(4.19 ± 0.42), (101.30 ± 9.67) o,(62.47 ± 6.16) points, t = 3.42, 4.64, 6.58, all P < 0.001). The time spent in stand-to-walk test and 10-meter walking test were (7.95 ± 1.48) minutes and (4.67 ± 0.63) minutes, respectively, which were significantly shorter than those in the control group [(13.41 ± 2.05) minutes, (6.24 ± 0.77) minutes, t = 8.23, 6.74, both P < 0.001). The incidence of falls in the study group was significantly lower than that in the control group (11.3% vs. 29.5%, χ 2 = 4.47, P = 0.034). There was no significant difference in total incidence of drug-related adverse reactions between the two groups (9.1% vs. 13.6%, χ 2 = 0.45, P = 0.502). Conclusion:Distal adductor block with cloprocaine combined with fentanyl meets the requirement of short-term intensive analgesia after total knee arthroplasty, and achieves sufficient analgesia, maximum retention of motor function, rapid onset, and repaid recovery.