Objective:To evaluate the efficacy of ultrasound-guided adductor canal approach to nerve block using one-puncture four-point technique for analgesia after total knee arthroplasty (TKA).Methods:Sixty patients of both sexes, aged 65-80 yr, with body mass index of 18-27 kg/m 2, of American Society of Anesthesiologists physical status Ⅱor Ⅲ, scheduled for elective unilateral TKA under general anesthesia, were enrolled in this study.Peripheral nerve block was performed for postoperative analgesia under ultrasound guidance.All the patients were allocated into 2 groups ( n=30 each) using a random number table method: adductor canal block combined with posterior approach to sciatic nerve block group (group ASB) and adductor canal approach to nerve block using one-puncture four-point technique including sciatic nerve, medial vastus muscle nerve, saphenous nerve, anterior femoral cutaneous nerve at adductor canal level group (group ANSB). When visual analogue scale score ≥4 during postoperative movement, ketorolac tromethamine 0.6 mg/kg was intravenously injected as rescue analgesic. The muscle strength of quadriceps on the affected side, range of knee joint motion and rate of the ability to walk for 10 m using the walker were recorded at 2, 8, 24 and 48 h after surgery.The consumption of analgesics for rescue analgesia, manipulation completion time, length of hospital stay and patients′ satisfaction score were recorded within 48 h after surgery. Results:Compared with group ASB, the consumption of ketorolac tromethamine was significantly reduced, manipulation completion time and length of hospital stay were shortened, patients′ satisfaction scores were increased, and the range of knee joint motion and rate of the ability to walk for 10 m using the walker were increased at 2, 8, 24 and 48 h after surgery in group ANSB ( P<0.05). There was no significant difference in muscle strength of quadriceps between two groups ( P>0.05). Conclusion:Ultrasound-guided adductor canal approach to nerve block using one-puncture four-point technique provides better efficacy than adductor canal block combined with posterior approach to sciatic nerve block when used for analgesia after TKA.

Objective To compare the effectiveness and feasibility of oral tracheal intubation with Clarus video stylet,HPHJ-A video laryngoscope and Airtraq laryngoscope and in snoring pa-tients.Methods Ninety patients undergoing elective snoring surgery with general anesthesia,3 9 males and 51 females,aged 22-55 years,BMI 25-29 kg/m2,ASA physical status Ⅰ-Ⅲ,were ran-domly divided into three equal-sized groups (n=30):Clarus Video Stylet group (group C),HPHJ-A video laryngoscope group (group H)and Airtraq laryngoscope group (group A).The time of success-ful endotracheal intubation and the success rate of initial intubation of all groups were observed.The mean arterial pressure (MAP),heart rate(HR)and Rate-pressure product(RPP)were also monitored before induction of anesthesia(T0),before tracheal intubation(T1),at 0 min(T2),1 min (T3),and 3 min (T4)after intubation,as well as the throat injury and hemorrhage were noted. Results Patients in group C were successful intubated.Two patients in group H and one patient in group A with failed intubation were successfully intubated by using Clarus video stylet.The time re-quired for successful intubation in group C was longer than groups H and A (P<0.05).Compared with T0,the increasing of hemodynamic parameters (MAP,HR,RPP)after induction of all groups were significant(P<0.05).Compared with T1,the HR,MAP and RPP were increased significantly at T2in all groups (P<0.05).Compared with T1,the MAP and RPP were increased significantly at T3in all groups,and the HR were increased significantly at T3in groups H and A (P<0.05).There was no significant difference in the HR between T1and T3in group C.The increase in the HR and RPP at T2 was lower in group C than that in both the groups H and A (P <0.05).The changes of hemodynamic parameters were no significant among the three groups at other time.The differences of sore throat score and hemorrhage were no significant.Conclusion Compared with HPHJ-A video laryngoscope and Airtraq laryngoscope,Clarus video stylet for guiding oral tracheal intubation in snoring patients have less influence on hemodynamic parameters,and have no limited mouth opening. But Clarus Video Stylet spends longer intubating times,and has no obvious advantages on preventing throat injury.