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| Effect of saphenous nerve block through inferior approach of medial femoris muscle in total knee arthroplasty in advanced age |
| MEI Peiyi1 WU Jimin1 WU Yini1 YE Lvju2 |
1.Department of Anesthesiology, Lishui People’s Hospital, Zhejiang Province, Lishui 323000, China;
2.Department of Obstetrics and Gynecology, Lishui Maternal and Child Health Hospital, Zhejiang Province, Lishui 323000, China
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Abstract Objective To explore the effect of saphenous nerve block through inferior approach of medial femoris muscle in total knee arthroplasty in advanced age. Methods A total of 104 advanced age patients with total knee arthroplasty admitted to Lishui People’s Hospital, Zhejiang Province from January 2020 to January 2022 were selected, they were divided into study group (52 cases) and control group (52 cases) according to the random number table method. The control group received sciatic nerve block anesthesia through lower outer approach of large rotor, and study group was anesthetized by saphenous nerve block through inferior approach of medial femoris muscle. Surgical indexes and nerve block indexes were compared between two groups; visual analogue scale (VAS) scores of resting and active state were compared between two groups before surgery (T0), 6 h after surgery (T1), 12 h after surgery (T2), 24 h after surgery (T3) and 48 h after surgery (T4); the knee function scores of two groups were compared one and six months after surgery; the occurrence of adverse reactions was observed. Results There were no significant differences in operation time, anesthesia completion time, sensory block onset time, sensory block maintenance time, motor block onset time, motor block maintenance time, and motor block effect score between two groups (P＞0.05); the sensory block effect score in study group was higher than that in control group, and the difference was statistically significant (P＜0.05). At T1, there were no significant differences in resting and active VAS scores between two groups compared with T0 (P＞0.05); at T2-T4, the resting and active VAS scores of two groups were higher than those at T0, and the differences were statistically significant (P＜0.05). At T0-T1, there was no significant differences in resting and active VAS scores between two groups (P＞0.05); At T2-T4, the resting and active VAS scores of study group were lower than those of control group, and the differences were statistically significant (P＜0.05). Six months after surgery, the knee function scores of two groups were higher than those of one month after surgery, and the differences were statistically significant (P＜0.05); one and six months after surgery, there was no significant difference in knee function scores between two groups (P＞0.05). There was no significant difference in the total incidence of adverse reactions between two groups (P＞0.05). Conclusion It is safe and reliable to apply saphenous nerve block through inferior approach of medial femoris muscle in total knee arthroplasty in advanced age, which can enhance analgesic effect and reduce postoperative pain.
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[1] 方雯，王秀红，汪俊华，等.术前衰弱对单侧全膝关节置换术后老年患者膝关节功能康复的影响研究[J].中国全科医学，2021，24（8）：968-976.
[2] 宋伟，张亚鑫，贾大洲，等.辅助应用地塞米松联合呋塞米对全膝关节置换后早期疼痛和肿胀的影响[J].中国组织工程研究，2022，26（33）：5317-5322.
[3] 张志军，段立鹏，徐惠青，等.超声引导腘窝上坐骨神经联合隐神经阻滞与椎管内麻醉在拇外翻手术中的临床比较[J].河北医药，2018，40（15）：2356-2358.
[4] 陈娟.超声引导下腘窝上和大转子下外侧入路坐骨神经阻滞应用于老年全膝关节置换术后镇痛的效果比较[J].蚌埠医学院学报，2020，45（9）：1180-1183.
[5] 王美容，柳垂亮，何妹仪，等.超声引导下收肌管入路一针四点法神经阻滞用于全膝关节置换术后镇痛的效果[J].中华麻醉学杂志，2020，40（6）：728-731.
[6] 谢莉.超声引导臂丛阻滞有效性和安全性的系统评价与案例分析[D].苏州：苏州大学，2014.
[7] 吴捷，王亚琴，陈杰，等.腰-硬联合麻醉在老年心血管病患者髋关节置换术中的麻醉效果及安全性观察[J].中国临床医生杂志，2018，46（10）：1218-1220.
[8] Chiarotto A，Maxwell LJ，Ostelo RW，et al. Measurement Properties of Visual Analogue Scale，Numeric Rating Scale，and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain：A Systematic Review [J]. J Pain，2019， 20（3）：245-263.
[9] Arroyo-Morales M，Martin-Alguacil J，Lozano-Lozano M，et al. The Lysholm score：Cross cultural validation and evaluation of psychometric properties of the Spanish version [J]. PLoS One，2019，14（8）：376-382.
[10] 孟雪，郑少强，肖蕊.全膝关节置换术后右美托咪定与罗哌卡因连续股神经阻滞的镇痛效果观察[J].中国骨与关节损伤杂志，2021，36（12）：1307-1309.
[11] 孙红妮，于卓梅，曲学丽.烟台市全膝关节置换术后患者肌肉骨骼健康状况及影响因素研究[J].中国卫生统计，2021，38（4）：611-614.
[12] 熊言顺，疏树华，王迪，等.右美托咪定复合尼卡地平在全身麻醉老年高血压患者全膝关节置换术的应用研究[J].重庆医学，2022，51（6）：924-928.
[13] 张春平.人工单髁关节置换术治疗单间室膝关节骨关节炎的效果及对并发症、关节功能的影响[J].中外医学研究，2022，20（35）：51-55.
[14] 李英俊，邱丽莎，王勃.膝关节内侧间室骨关节炎患者采用膝关节单髁置换术对手术相关指标与膝关节功能的影响[J].中国医药科学，2022，12（24）：133-137.
[15] 蔡传凤，阮仁芝，余新颜.分阶段康复干预在膝关节置换术患者中应用对术后疼痛及功能恢复的影响[J].中国医药导报，2023，20（1）：190-193.
[16] 刘颖，涂芸芸，黄冰.超声引导下神经阻滞复合全身麻醉对全膝关节置换术患者镇痛效果及血流动力学的影响[J].中国当代医药，2022，29（18）：115-118，122.
[17] 杜明明，张宽，曾纪洲，等.全膝关节置换胫骨平台截骨后倾角对关节接触力的影响[J].北京生物医学工程，2021，40（3）：227-232，238.
[18] 陈洁茹，胡继成，陈家琪，等.术前疼痛灾难化和全膝关节置换术后慢性疼痛的相关性[J].临床麻醉学杂志，2022，38（7）：721-725.
[19] 赵潇雄，张博，任世祥，等.局部浸润麻醉对全膝关节置换术后早期镇痛效果的影响[J].首都医科大学学报，2021，42（1）：138-142.
[20] 樊林滨，杨荣国.超声引导下腘窝上坐骨神经阻滞在足部手术患者中的应用[J].海南医学，2021，32（5）：624-627.
[21] 芦海燕，孟根其其格，金月，等.超声引导联合神经刺激隐神经阻滞干预全膝关节置换术后患者的效果[J].中国介入影像与治疗学，2020，17（3）：167-171.
[22] 夏林智，雷震，杨晶晶，等.收肌管隐神经阻滞麻醉在单侧全膝关节置换术老年患者中的应用效果[J].广西医学，2022，44（12）：1328-1331.
[23] 张成栋，刘群，江海滨，等.超声引导下连续隐神经阻滞用于老年患者全身麻醉下单侧全膝关节置换术超前镇痛的效果观察[J].中国医师进修杂志，2021，44（10）：939- 943.
[24] 冯腾尘，王佳奕，姚杰，等.隐神经联合膝关节囊后阻滞对全膝置换术后认知功能及镇痛效果的影响[J].中国现代医学杂志，2022，32（19）：73-79.
[25] 高芳，解凤磊，刘伟，等.四种麻醉方法对全膝关节置换术患者的影响[J].湖南师范大学学报：医学版，2021，18（3）：237-240.
[26] 刘凯缘，杨东，徐天阳，等.经股内侧肌入路全膝关节置换术中髌骨位置对软组织平衡及临床疗效的影响[J].中华骨科杂志，2020，40（7）：433-440.
[27] 刘云可，郑稼.股内侧肌下入路联合加速康复外科理念应用对全膝关节置换术后康复的影响[J].中华实用诊断与治疗杂志，2020，23（2）：132-134.
[28] 高旭琴，范俊柏，赵小雨，等.超声引导下腘窝坐骨神经联合隐神经阻滞对胫腓骨骨折术后镇痛的疗效研究[J].西部医学，2019，31（11）：1704-1708.
[29] 钱玉莹，潘蓓，凌祥伟，等.超声引导下2种入路收肌管神经阻滞对全膝关节置换术后镇痛和运动功能的影响[J].重庆医学，2022，51（22）：3903-3906.
[30] 王泽峰.膝前内侧切口股内侧肌下入路中直视下隐神经阻滞对全膝关节置换术后的镇痛作用[J].中华医学杂志，2021，（21）：1592-1597. |
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