OBJECTIVE: To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). METHODS: A prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups ( n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups ( P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. RESULTS: In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels ( P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group ( P>0.05), there were significant differences at other time points of two groups compared to preoperative score ( P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours ( P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points ( P<0.05). No significant difference was found in Bromage motor block scores between the groups ( P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference ( P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups ( P>0.05). CONCLUSION Ultrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Nerve Block/methods* ; Male ; Female ; Pain, Postoperative/etiology* ; Tourniquets/adverse effects* ; Prospective Studies ; Middle Aged ; Ropivacaine/administration & dosage* ; Aged ; Ultrasonography, Interventional ; Anesthetics, Local/administration & dosage* ; Pain Measurement ; Fascia ; Osteoarthritis, Knee/surgery* ; Treatment Outcome ; Arthritis, Rheumatoid/surgery*

OBJECTIVE: To compare the effects of different concentrations of ropivacaine femoral nerve block on postoperative pain and early exercise fllowing total knee arthroplasty(TKA). METHODS: A total of 90 patients who underwent primary TKA between September 2022 and February 2023 were consecutively enrolled in this study. The cohort consisted of 34 males and 56 females, with a mean age of (66.66±7.03) years old. According to different concentrations of ropivacaine, patients were divided into 0.1% group, 0.2% group and 0.4% group, with 30 patients in each group. The age, gender, body mass index(BMI), American Society of Aneshesiologists(ASA) grade, operation time, anesthesia time, tourniquet using time, Post Anesthesia care unit(PACU) stay duration, ambulation time, first reaching to Bromage 0 grade time, visual analogue scale(VAS), hospitalization period and postoperative adverse reactions were compared among the three groups. RESULTS: All 90 patients were followed up for an average of (31.56±5.62) days, and no postoperative adverse reactions occurred. There were no significant differences among the three groups in terms of age, gender, BMI, ASA classification, operation time, anesthesia time, tourniquet application time, PACU stay duration, and hospitalization period (P>0.05). Significant differences were observed in VAS scores at 1, 2, 4, 6, and 12 hours post-operation among the three groups (P<0.05). Additionally, significant variations were noted in ambulation time and the first reaching to Bromage level 0 time among the three groups (P<0.05). In terms of postoperative pain, the VAS of the 0.1% group at 1, 2, 4, 6, and 12 hours after surgery(1.93±0.52), (2.57±0.77), (3.10±0.71), (3.10±0.71), (3.07±0.45) points were higher than those of the 0.4% group (1.57±0.50), (2.10±0.55), (2.23±0.57), (2.47±0.73), (2.50±0.57) points, and the differences were statistically significant (P<0.05);the VAS of the 0.1% group at 4, 6, and 12 hours after surgery were higher than those of the 0.2% group (2.43±0.57), (2.53±0.57), (2.63±0.56) points, and the differences were statistically significant (P<0.05);there was no statistically significant difference in VAS between the 0.2% group and the 0.4% group (P>0.05). In terms of early postoperative mobility, the time to ambulation time (8.30±2.76) h and the time to achieve the first Bromage grade 0 (6.13±2.18) h were significantly prolonged in the 0.4% group compared to both the 0.1% group (6.93±1.76) h, (4.17±1.18) h and the 0.2% group (6.53±1.59) h, (4.87±1.53) h. No statistically significant differences were observed between the 0.1% and 0.2% groups (P>0.05). CONCLUSION 0.2% ropivacaine femoral nerve block can effectively reduce postoperative pain after TKA and can perform early exercise earlier.
Humans ; Male ; Female ; Ropivacaine/administration & dosage* ; Arthroplasty, Replacement, Knee/adverse effects* ; Aged ; Nerve Block/methods* ; Femoral Nerve/drug effects* ; Middle Aged ; Pain, Postoperative/drug therapy* ; Anesthetics, Local/administration & dosage* ; Amides

OBJECTIVE: To investigate the behavioral and ultrastructural changes of intrathecal administration of different concentrations of ropivacaine for 12 h. METHODS: Thirty male SD rats were randomly divided into 5 groups (6 rats in each group):group N (control), group A (ropivacaine 0.25%), group B (ropivacaine 0.5%), group C (ropivacaine 0.75%),and group D (ropivacaine 1.0%). A polyurethane microcatheter was inserted into the lumbar subarachnoid space 8 cm according to Yakshos intrathecal administration. The rats in group N received saline 0.12 mL/kg for 8 times at 1.5 h interval through the catheter, and the rats in the other groups received different concentrations of ropivacaine in the same way as in group N. The poster paw withdrawal latency to heat (PWHL) and mechanical stimulation (von Fray filament) (PWML) were measured the day before the intrathecal administration and 12 hours after the first intrathecal administration of ropivacaine. Motor function (MF) was measured after the last intrathecal administration. After the behavior test, the rats were sacrificed and the lumber segments of the spinal cord were immediately removed for electron microscopic examination. RESULTS: A total hind limb paralysis was seen at 30 seconds and intramuscular strain gradually came back 10~60 minutes after the intrathecal administration of ropivacaine in group A, B, C, and D, but not in group N. The recovery time of motor block of group A was the shortest (P<0.05), that of group D was the longest,and that of group B and C was between group A and D. Intrathecal administration of different concentrations of ropivacaine did not affect the percent maximum possible effect (%MPE) of PWHL and PWML. Electron microscopic examination showed that the spinal cords were normal in group N and A, slight edema of mitochondria and endoplasmic reticulum (ER) in group B, loosened fibrous layers in medullary sheath, edema and local degeneration of neuraxis in group C,and shrinkage of nuclear membrane, serious edema of ER, vacuolus change of mitochondria and local demyelination in group D. CONCLUSION Ropivacaine (0.5%, 0.75%, and 1.0%) administered intrathecally for 12 hours causes different degrees of ultrastructural changes in the spinal cord depending on concentrations.
Amides ; administration & dosage ; toxicity ; Anesthetics, Local ; administration & dosage ; toxicity ; Animals ; Behavior, Animal ; drug effects ; Dose-Response Relationship, Drug ; Injections, Spinal ; Male ; Microscopy, Electron ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Ropivacaine ; Spinal Cord ; ultrastructure

OBJECTIVE: To explore the alterations of serum of myelin basic protein (MBP) concentration in the plasma and ultrastructure in the spinal cord after continuous intrathecal injection of different ropivacaine concentrations in rats. METHODS: Ninety-six male Sprague-Dawley rats weighing 220 to approximately 280 g were randomly divided into a control group (Group N), Group R(1), R(2) and R(3) (24 rats in each group). Each group was subdivided into 4 subgroups (6 rats in each subgroup). According to the method of Yaksh's, a polyurethane microspinal catheter was inserted into the lumbar subarachnoid space in which 8 cm segment was left. Rats in each group were continuously received 40 microL of intrathecal injection of normal saline(Group N), 0.5%, 0.75%, and 1.0% ropivacaine (Group R(1),R(2),R(3)), 3 times every 1.5 hours. Blood (0.5 mL) was drawn from the femoral artery to determine serum concentrations of MBP at the detecting time T(0)(before inserted pipe)and T(1)(before the first intrathecal injection); for the subgroups, the examining time was at T(2), T(3), T(4) and T(5)(6, 12, 24 and 48 h respectively after the last time intrathecal administration). After blood was drawn, the rats in each subgroups were decapitated and the spinal cord of L(1-2) intumescentia lumbalis were immediately removed for electronic microscopic examination. RESULTS: MBP levels were comparatively steady in Group N, R(1) and R(2), while there was statistical difference between Group R(3) and Group N, R(1),R(2),and R(3) (P<0.05). MBP level of Group R(3) was significantly higher at T(2),T(3),T(4) and T(5) than that at T(0)(P<0.01). The ultrastructural changes of the spinal cord in Group R(3) were pycnosis of most neurons, dilation of most rough endoplasmic reticulum, and vague structure of mitochondria and endocytoplasmic reticulum. A few neurons were completely de-generated losing the normal structure, with vacuole degeneration of crista mitochondriales or even partial loss. CONCLUSION The spinal cord ultrastructure is selectively vulnerable after intrathecal 1.0% ropivacaine injection, which may be one of the important pathophysiological bases for local anesthetic neurotoxicity. MBP may serve as a sensitive and specific indicator of spinal cord damage after intra-thecal administration of ropivacaine.
Amides ; administration & dosage ; pharmacology ; Anesthetics, Local ; administration & dosage ; pharmacology ; Animals ; Injections, Spinal ; methods ; Male ; Myelin Basic Protein ; Nerve Tissue Proteins ; blood ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Ropivacaine ; Spinal Cord ; ultrastructure ; Transcription Factors ; blood

OBJECTIVE: To explore the feasibility of epidural anesthesia with ropivacaine by computerized infusion pump. METHODS: Sixty patients scheduled for obstetric operation were divided into a continuous pump infusion group (Group A, n=30) and a conventional injection group (Group B, n=30). The initial doses of 0.75% ropivacaine 12 mL and 15 mL were respectively injected into the patient's epidural space in Group A and Group B. The dose of 6 mL of 0.75% ropivacaine per hour was continuously pumped to maintain the anesthesia till the end of the operation in Group A, and 6 mL of 0.75% ropivacaine was injected 80 min later in Group B. RESULTS: Blood pressure in some patients markedly decreased at 90 min after the first injection in Group B while it is relatively stable in Group A (P<0.05). The number of patients who had to inject ephedrine to raise the blood pressure in Group A was smaller than that in Group B during the operation (P<0.05). There was no significant difference in the anesthetic level between Group A and Group B (P>0.05). CONCLUSION Epidural anesthesia with ropivacaine by computerized infusion pump is safe, which can not only provide an excellent anesthetic effect but also keep the hemodynamics stable.
Adult ; Amides ; administration & dosage ; Analgesia, Epidural ; instrumentation ; methods ; Analgesia, Obstetrical ; instrumentation ; methods ; Anesthetics, Local ; administration & dosage ; Blood Pressure ; drug effects ; Computers ; Female ; Humans ; Infusion Pumps ; Middle Aged ; Pregnancy ; Ropivacaine ; Time Factors