In ERAS, the goals of pain management are to minimize postoperative pain, promote early recovery and rehabilitation, and improve the patient’s functional outcomes. The ERAS model was first proposed by Professor Henrik Kehlet at the Copenhagen University in Denmark in 1997, and it was introduced to China by academician Jieshou Li in 2006. However, this method cannot prevent posterior knee pain. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. 6 6 Elkassabany NM, Antosh S, Ahmed M, et al. Studies have confirmed that an adductor canal block has satisfactory analgesic effects and does not affect quadriceps femoris muscle strength consequently, it could replace the femoral nerve block. The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta-analysis. 5 5 Grape S, Kirkham KR, Baeriswyl M, et al. Additionally, it can easily cover up peroneal nerve injuries, which occur frequently, as well as other nerve injuries that take place during the operation. Femoral nerve block combined with sciatic nerve block is used for postoperative analgesia while this achieves a satisfactory analgesic effect, it presents the issues of quadriceps femoris weakness and calf weakness, which limit early autonomic exercise and activity of the joints and increase the risk of falls after surgery. Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and metaanalysis. Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis. Within the model of Enhanced Recovery After Surgery (ERAS), it is required that a patient’s pain should be fully controlled after the operation to help achieve early limb autonomous movement, speed up the rehabilitation process, shorten hospital stays, and improve patient satisfaction. Analgesia for total knee arthroplasty: a review of lower extremity nerve blocks. Pain is the most difficult factor to control following TKA however, the development of an ultrasoundguided nerve block has helped to reduce postoperative pain to a certain extent. However, despite the effectiveness of this approach, the rehabilitation of limbs after a TKA operation still faces critical challenges. An experience and evidencebased approach to care. Rehabilitation after hip and kneejoint replacement. Total Knee Arthroplasty (TKA) is the best treatment option for patients with end-stage joint disease as it provides the benefits of relieving pain and improving joint function. IPACK Peripheral nerve blocks Regional anesthesia Adductor canal block Total knee arthroplasty Conclusion:Ĭompared with femoral nerve block combined with superior popliteal sciatic nerve block, IPACK combined with adductor canal block had a mild impact on early motor functions after TKA. The quadriceps femoris muscle strength score was significantly higher in I group than in FS group ( p = 0.001), while the modified Bromage score were significantly lower and walking distance results were significantly higher in I group than in FS group (both p = 0.000). Post-operation, all the patients received patient-controlled intravenous analgesia combined with an oral celecoxib capsule to relieve pain and maintain a visual analogue scale score of ≤ 3. Before anesthesia induction was completed, the patients in I group received an ultrasound-guided adductor canal block with 15 mL of 0.375% ropivacaine and an IPACK block with 25 mL of ropivacaine, and the patients in FS group received a femoral nerve block and a superior popliteal sciatic nerve block with 20 mL of 0.375% ropivacaine under ultrasound guidance. Methods:Ī sample of 60 cases who were scheduled for elective unilateral TKA were divided into two groups using random number table method: a group with IPACK combined with an adductor canal block (I group, n = 30), and a group with femoral nerve block combined with superior popliteal sciatic nerve block (FS group, n = 30). This study aimed to evaluate the impact of Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) combined with an adductor canal block under the guidance of ultrasound on early motor function after Total Knee Arthroplasty (TKA).
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