Application of General Anesthesia Combined with Saphenous Nerve-Tibial Nerve Block in Total Knee Arthroplasty

Abstract

Background. The study aimed to evaluate the safety and efficiency of the saphenous nerve plus selective tibial nerve block combined with general anesthesia in total knee replacement surgery (TKRS). Methods. Sixty-four patients who underwent unilateral TKRS between October 2019 and June 2020 were selected as study subjects. All patients were divided into the control and observation groups using the random number table method, with 32 patients in each group. Conventional general anesthesia was performed preoperatively in both groups. The control group was given an ultrasound-guided saphenous nerve block before anesthesia induction, and the observation group was given a selective tibial nerve block on the basis of the control group. The dosage of general anesthetic drugs, recovery time from general anesthesia, hemodynamic index, inflammatory response, postoperative analgesic effect, and adverse reaction rate were compared between the two groups. Results. Compared with the control group, the total amount of propofol and remifentanil used in the observation group was significantly less ( $P<0.05$ ). Compared with the control group, patients in the observation group experienced remarkably shorter time to recovery from respiration, time to extubation, and time in the PACU ( $P<0.05$ ). Compared with the control group, the observation group showed a significantly reduced SBP and MAP at T2, T3, and T4, respectively, and also showed a prominently lower HR at T3 and T4 ( $P<0.05$ ). Markedly lower CRP and IL-6 levels at 6 h and 24 h after surgery were found in the observation group compared to the control group ( $P<0.05$ ). Compared with the control group, patients receiving nerve block intervention got significantly lower VAS scores at 6 h, 24 h, and 48 h postoperatively ( $P<0.05$ ). However, there was no statistically significant difference in the incidence of adverse reactions between the two groups of patients ( $P>0.05$ ). Conclusion. The application of the saphenous nerve plus selective tibial nerve block combined with general anesthesia in TKRS yields a promising analgesic effect, stable hemodynamics, low levels of postoperative inflammatory responses, and high safety.