1.Efficacy of preoperative femoral nerve block for preemptive analgesia in elderly patients undergoing total knee arthroplasty under general anesthesia
Zhouquan PENG ; Wei ZHANG ; Yanli MA ; Liwei LI
Chinese Journal of Anesthesiology 2015;35(3):314-316
Objective To evaluate the efficacy of preoperative femoral nerve block on preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.Methods Sixty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 65-75 yr,scheduled for elective total knee arthroplasty,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group Ⅰ),preoperative femoral nerve block group (group Ⅱ) and postoperative femoral nerve block group (group Ⅲ).Single-injection femoral nerve block was performed with 0.375% ropivacaine 20 ml injected around the nerve under thc guidance of ultrasound immediately before induction of anesthesia and at the end of surgery in Ⅱ and Ⅲ groups,respectively.Patient-controlled intravenous analgesia (PCIA) with sufentanil (background infusion 2 ml/h,bolus dose 2 ml,lockout interval 15 min) was used until 2 days after surgery,and VAS score was maintained ≤ 3.When VAS score>3,flurbiprofen axetil 50 mg was injected intravenously as rescue medication.The consumption of sufentanil per hour,requirement for rescue medication,and development of adverse reactions were recorded within 24 h after surgery.Sufentanil-sparing degree was calculated.Results Compared with group Ⅰ,the consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly decreased within 24 h after surgery in Ⅱ and Ⅲ groups.The consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in group Ⅱ than in group Ⅲ.The consumption of sufentanil per hour was decreased by 35% in group Ⅱ as compared with group Ⅰ,and decreased by 18% in group Ⅱ as compared with group Ⅲ.Conclusion Preoperative femoral nerve block can provide good preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.