超声引导下 IPACK 神经阻滞联合 ACB 在老年 全膝关节置换术后镇痛中的应用效果.

Objective To investigate the effect of ultrasound-guided infiltration between the popliteal artery and the capsule of the knee（IPACK) block combined with adductor canal block（ACB) on postoperative analgesia after total knee arthroplasty（TKA) in the elderly patients. Methods Totally 126 elderly patients who underwent elective primary unilateral TKA were selected and divided into the ACB group, IPACK group, and IPACK+ACB group, with 42 cases in each group. In the ACB group, a PCIA pump was connected after surgery and ACB was performed under ultrasound guidance; in the IPACK group, IPACK block was performed on the side of the operation after neuraxial anesthesia was completed and before the operation began, and the PCIA pump was connected after the operation; in the IPACK+ACB group, IPACK block was performed on the side of the operation after neuraxial anesthesia was completed and before the operation began, the PCIA pump was connected and the ultrasound-guided ACB was performed after surgery. At 8, 12, 24 and 48 h after surgery, the patients were assessed by visual analogue scale（VAS) at rest, activity and posterior knee joints to evaluate the degree of pain. The maximum angle of active knee flexion was measured at 24 and 48 h after operation, and the active range of motion of the knee joint was evaluated. The number of effective compressions and the number of salvage analgesia of the postoperative PCIA pump were recorded, and the rate of salvage analgesia was calculated. The occurrence of adverse reactions within 24 h after surgery was observed, including nausea and vomiting, dizziness, nerve damage, infection and bleeding at the nerve block puncture site, etc. Satisfaction scores were given to patients. Results At 8 h and 12 h after surgery, the VAS at rest and during activity in the ACB group and IPACK+ACB group were lower than those in the IPACK group, and the posterior knee VAS in the ACB group was higher than that in the other two groups（all P＜0. 05）, and at 24 h and 48 h after surgery, there were no significant differences in resting, active and posterior knee VAS between the three groups（all P＞0. 05）. At 24 h after operation, the maximum angle of active knee flexion in the IPACK+ACB group was greater than that in the other two groups（all P＜0. 01）, and there was no significant difference in the maximum angle of active knee flexion between the three groups at 48 h after surgery（P＞0. 05）. Compared with the IPACK group, the rate of salvage analgesia within 24 h in the ACB group and the IPACK+ACB group was reduced, the patient satisfaction rate increased, and the incidence of nausea and vomiting decreased（P＜0. 05 or P＜0. 01）. Conclusions ACB combined with IPACK block can reduce posterior knee pain, increase knee active range of motion, and do not increase the incidence of postoperative adverse reactions, which can provide good postoperative analgesia for elderly TKA patients. [ABSTRACT FROM AUTHOR]