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Purpose: To evaluate the efficacy and safety of different types of anesthesia (LA, LA with IVA, and GA) used during PKP.Patients and methods: A total of 150 patients of single-level OTLF were prospectively included in this study from February 2019 to February 2020. They were randomly divided into three groups of 50 patients each and treated with GA, LA, or LA with IVA. Severity of back pain was measured preoperatively, intraoperatively, and 1 h, 1 day, 1 month, and 1 year postoperatively using VAS scores. The ODI was administered and the AHVB on lateral thoracolumbar radiographs was measured preoperatively and at 1 month and 1 year postoperatively. The MMSE was administered at 1 and 7 days postoperatively to monitor for the development of POCD.Results: 131 patients completed the full postoperative follow-up schedule. The average duration of surgery in the LA group was slightly longer than the other two groups. The intraoperative VAS score of the LA+IVA group was significantly lower than that of the LA group. The MMSE scores at 1 day and 1 week postoperatively were significantly decreased only in the GA group. The incidence of POCD was 45% (18/40) at 1 day and 5% (2/40) and at 1 week postoperatively in the GA group, whereas POCD was not observed in the other two groups. The GA group had the highest incidence of anesthesia-related adverse reactions.Conclusion: IVA with ropivacaine can effectively reduce intraoperative and early postoperative pain, shorten the duration of surgery, reduce surgery-related complications.

BACKGROUND Peripheral nerve block has an anti-inflammatory effect that is confirmed in animal studies, while inconclusive in human studies. Dexmedetomidine (DEX), a highly selective α2-adenoceptor agonist, has a potent anti-inflammatory effect. The aim of this study was to evaluate the effect of DEX added to ropivacaine for femoral nerve block (FNB) on local inflammatory response after total knee arthroplasty (TKA). METHODS Sixty patients scheduled for TKA were randomized into two equal groups in a prospective randomized study. They were all treated with FNB preoperatively. In group R, 20 mL of 0.5% ropivacaine were injected for the block; in group RD, 20 mL of 0.5% ropivacaine plus 1 µg/kg DEX were administered. Visual Analog Scale (VAS), the circumference of the operated knee, and the concentration of interleukin-6 (IL-6) and prostaglandin E2 (PGE2) in joint fluid were evaluated. Adverse events such as hypotension, bradycardia and hypoxia were recorded. RESULTS VAS was lower in group RD for 12 to 48 hours after surgery (P

To observe the effect of femoral and sciatic nerve block on tourniquet reaction and postoperative pain during total knee arthroplasty (TKA).Totally 60 patients scheduled for TKA were equally divided into two groups according to the random number table (n=30):femoral nerve block (F) group and femoral and sciatic nerve block (SF) group. The changes of mean arterial pressure (MAP) and heart rate (HR) in each group were recorded at the tourniquet inflated immediately (T1),30 minutes (T2),60 minutes (T3),90 minutes (T4),loose tourniquet (T5) and post extubation (T6). The total amount of anesthetics drugs propofol and remifentanil were calculated. The pain score after extubation and the location of pain were recorded.MAP and HR in group SF were steady at T1-T6 (all P0.05). Compared with group SF,MAP in group F were significantly increased at T2-T4 and T6 (all P0.05),and the HR at T4 and T6 were significantly increased (all P0.05). Compared with the group F,the total amount of propofol and remifentanil were significantly decreased in group SF (all P0.05),and pain scores at rest and on movement were reduced (P0.05);in addition,90% patients in group F complained of posterior popliteal pain.Femoral nerve and sciatic nerve block applied in TKA can obviously inhibit the tourniquet reaction,keep hemodynamic stability,reduce the dosage of anesthetic drug,and relieve the postoperative pain.