Effects of ultrasound-guided adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty

doi:10.11958/20231230

Abstract

Abstract:

Objective To investigate the impact of adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty (TKA). Methods A total of 72 elderly patients undergoing elective TKA were selected and divided into the control group and the observation group with 36 patients in each group using a random number table method. The control group was given simple general intravenous anesthesia, and the observation group received adductor canal block under ultrasound guidance combined with general anesthesia. Both groups of patients were connected to patient-controlled intravenous analgesia (PCIA) pumps after surgery. Data of heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at the time of entering the operating room (T0), insertion of the laryngeal mask (T1), 30 minutes after the start of surgery (T2) and the end of surgery (T3). Visual analog scale (VAS) pain scores were recorded in the first 48 hours postoperatively. Levels of C-reactive protein (CRP), interleukin-6 (IL-6) and Mini-Mental State Examination (MMSE) scores were recorded 3 days after surgery. Additionally, the dosage of propofol and sufentanil, PCIA press times, awakening time, extubation time, first time out of bed and length of hospital stay were compared between the two groups. Results Compared with the control group, the observation group showed a decrease in HR at T1 and T3, and an increase in SBP and DBP (P<0.05). In comparison with the control group, the observation group showed lower VAS scores，along with reduced CRP and IL-6 levels，and higher MMSE scores (P<0.05) at the same postoperative time points. Patients in the observation group showed reduced doses of propofol and sufentanil, fewer PCIA presses, shorter postoperative recovery, extubation, first time out of bed and hospital stay than those of patients in the control group (P<0.05). Conclusion The application of ultrasound-guided adductor canal block combination with general anesthesia helps alleviate postoperative pain, relieve stress responses and improve cognitive function level in elderly patients with total knee replacement surgery.

Key words: arthroplasty, replacement, knee, nerve block, pain, postoperative, inflammation, aged, cognitive dysfunction

CLC Number:

R687.42，R614

Figures/Tables 7

References 22

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组别	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）
对照组	13/23	70.19±5.00	22.25±3.01	23/13
观察组	11/25	69.11±5.15	22.11±2.95	20/16
χ²或t	0.250	0.906	0.194	0.520

组别	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）
对照组	13/23	70.19±5.00	22.25±3.01	23/13
观察组	11/25	69.11±5.15	22.11±2.95	20/16
χ²或t	0.250	0.906	0.194	0.520

组别	丙泊酚/mg	苏醒时间/min	拔管时间/min	首次下床时间/h	住院时间/d
对照组	582.19±50.62	14.95±3.00	18.20±3.48	51.95±7.11	9.71±4.31
观察组	489.87±52.29	8.87±2.65	10.73±2.84	36.41±6.33	7.58±1.93
t	7.611^＊＊	9.126^＊＊	9.990^＊＊	11.683^＊＊	2.692^＊＊

组别	丙泊酚/mg	苏醒时间/min	拔管时间/min	首次下床时间/h	住院时间/d
对照组	582.19±50.62	14.95±3.00	18.20±3.48	51.95±7.11	9.71±4.31
观察组	489.87±52.29	8.87±2.65	10.73±2.84	36.41±6.33	7.58±1.93
t	7.611^＊＊	9.126^＊＊	9.990^＊＊	11.683^＊＊	2.692^＊＊

组别	HR/（次/min）
组别	T0	T1	T2	T3
对照组	76.39±5.64	97.53±7.91	84.68±4.02	79.72±4.40
观察组	76.13±4.31	95.70±6.59	80.79±3.76	79.76±3.73
组别	SBP/mmHg
组别	T0	T1	T2	T3
对照组	138.72±13.37	108.45±13.01	104.62±16.81	120.07±14.80
观察组	139.15±15.32	115.69±14.76	123.95±11.23	133.10±17.52
组别	DBP/mmHg
组别	T0	T1	T2	T3
对照组	89.76±11.08	73.92±5.67	77.94±7.24	80.62±7.45
观察组	85.81±10.46	79.42±5.22	82.57±6.67	84.83±6.06