Comparison of the Effects of Adductor Canal and Femoral Nerve Blocks on Postoperative Opioid Consumption and Inflammatory Factor Levels in Elderly Patients After Total Knee Arthroplasty: A Prospective Observational Study.

Purpose: Total Knee Arthroplasty (TKA) is a highly invasive procedure causing severe postoperative pain, which hampers early mobility. Effective pain management is crucial for optimal recovery. This study aimed to evaluate how adductor canal block (ACB) and femoral nerve block (FNB) affect opioid use and inflammation factor levels in elderly TKA patients. Methods: This prospective observational study included 120 patients who received TKA, and divided them into three groups, based on the different nerve block technique: ACB, FNB, and no intervention before general anesthesia (CON). Postoperative opioid consumption, pain assessment, inflammation factor, knee function recovery and other clinical indicators were recorded. Results: The CON group had significantly higher cumulative sufentanil consumption compared to the ACB and FNB groups at both 12 h and 48h postoperative (P<0.001). Compared with the CON group, the ACB and FNB groups persistently had lower pain scores until 12 h at rest and 24 h during motion after surgery. The ACB group showed significantly lower serum concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) compared to the CON group at 24 h postoperative (P=0.017, P=0.009), and IL-6 levels remained significantly lower at 72 h postoperative (P=0.005). Both ACB and FNB groups achieved earlier ambulation compared to the CON group (P=0.002). On the first day postoperative, both the ACB and FNB groups showed significantly better knee motion (P<0.001), quadriceps strength (P<0.001), and daily mobilization (P<0.001) compared to the CON group. Additionally, the ACB group exhibited superior quadriceps strength (P<0.001) and daily mobilization (P<0.001) compared to the FNB group. Conclusion: The ACB and FNB groups exhibited comparable clinical efficacy outcomes in terms of pain scores and opioid consumption. However, the ACB group experienced reduced postoperative inflammation and improved knee recovery, especially in quadriceps strength.

Development of implantable electrode based on bioresorbable Mg alloy for tissue welding application.

An implantable electrode based on bioresorbable Mg-Nd-Zn-Zr alloy was developed for next-generation radiofrequency (RF) tissue welding application, aiming to reduce thermal damage and enhance anastomotic strength. The Mg alloy electrode was designed with different structural features of cylindrical surface (CS) and continuous long ring (LR) in the welding area, and the electrothermal simulations were studied by finite element analysis (FEA). Meanwhile, the temperature variation during tissue welding was monitored and the anastomotic strength of welded tissue was assessed by measuring the avulsion force and burst pressure. FEA results showed that the mean temperature in the welding area and the proportion of necrotic tissue were significantly reduced when applying an alternating current of 110 V for 10 s to the LR electrode. In the experiment of tissue welding ex vivo, the maximum and mean temperatures of tissues welded by the LR electrode were also significantly reduced and the anastomotic strength of welded tissue could be obviously improved. Overall, an ideal welding temperature and anastomotic strength which meet the clinical requirement can be obtained after applying the LR electrode, suggesting that Mg-Nd-Zn-Zr alloy with optimal structure design shows great potential to develop implantable electrode for next-generation RF tissue welding application.