To study the effectiveness of ACB and iPACK block with liposomal bupivacaine for postoperative analgesia in patients undergoing knee arthroplasty
The pain after knee arthroplasty limits the patient's activities and postoperative recovery, and currently there are mainly three analgesic methods: intravenous analgesia, epidural analgesia and nerve block analgesia. There is a lack of studies on whether liposomal bupivacaine, if used for ACB and iPACK block, can achieve benefits in knee arthroplasty pain management by prolonging sensory nerve block without affecting muscle strength, improving patient prognosis, and shortening hospitalization days. In this study, in order to better evaluate the effect of liposomal bupivacaine for ACB and iPACK biock on the prognosis of patients undergoing knee arthroplasty, not only the NRS and AUC of patients in each group will be observed, but also the postoperative QoR-15 Quality of Recovery Rating Scale, postoperative nausea, vomiting and other complications, and the number of hospitalization days will be also included as observation indicators. The completion of this study can provide a clinical basis for the selection of analgesic regimens for knee arthroplasty, and also provide strong evidence-based medical support for the relevant medical decision making of government departments.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
90
When the MOAA/S score is 5 after the surgery,the PCIA pump equipped with sufentanil injection will be connected,if the patient's resting NRS ≥ 4 points , they should be given sufentanil 5 ug intravenously at intervals of more than 8 minutes until NRS ≤ 3.
When the MOAA/S score is 5 after the surgery,the PCIA pump equipped with sufentanil injection will be connected,if the patient's resting NRS ≥ 4 points , they should be given sufentanil 5 ug intravenously at intervals of more than 8 minutes until NRS ≤ 3.
Nanjing First Hospital
Nanjing, Jiangsu, China
RECRUITINGThe cumulative use of analgesic drugs (sufentanil,calculated in ug)up to 48 hours postoperative in each group
To study the effectiveness of ACB and iPACK block with liposomal bupivacaine for postoperative analgesia in patients undergoing knee arthroplasty.A lower dose of analgesics indicates a longer duration of block.
Time frame: Up to 48 hours postoperative
NRS scores at rest and during exerciseat at 2 hours, 4 hours, 8 hours, 12 hours, 24 hours, 36 hours, 48 hours and 72 hours postoperative
The NRS typically consists of a straight line with numbers ranging from 0 to 10. Each number corresponds to a level of pain intensity:0: No pain.1 to 3: Mild pain （low intensity）. 4 to 6: Moderate pain （moderate intensity）. 7 to 10: Severe pain (high intensity) Patients are asked to choose a number that best represents their current pain level, where 0 means no pain, and 10 indicates the worst possible pain.A lower NRS score indicates a longer duration of block.
Time frame: at 2 hours, 4 hours, 8 hours, 12 hours, 24 hours, 36 hours, 48 hours and 72 hours postoperative
The total number of PCIA compressions on the first day,the second day and the third day after surgery.
Fewer total PCIA compressions indicated a longer duration of block.
Time frame: On the first day,the second day and the third day after surgery.
The number of effective PCIA compressions on the first day,the second day and the third day after surgery.
Fewer total effective PCIA compressions indicated a longer duration of block.
Time frame: On the first day,the second day and the third day after surgery.
The number of times of remedial analgesia on the first day,the second day and the third day after surgery.
Fewer times of rescue analgesia indicated a longer duration of analgesia.
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When the MOAA/S score is 5 after the surgery,the PCIA pump equipped with sufentanil injection will be connected,if the patient's resting NRS ≥ 4 points , they should be given sufentanil 5 ug intravenously at intervals of more than 8 minutes until NRS ≤ 3.
Time frame: On the first day,the second day and the third day after surgery.
The cumulative use of analgesic drugs (sufentanil,calculated in ug)on the first day,the second day and the third day after surgery.
Less cumulative use of analgesics indicates a longer duration of block
Time frame: On the first day,the second day and the third day after surgery.
The percentage of subjects who did not use remedial analgesics on the first day,the second day and the third day after surgery.
A greater percentage of subjects who did not use rescue analgesics indicated a longer duration of analgesic block.
Time frame: On the first day,the second day and the third day after surgery.
Satisfaction score of subjects on the first day,the second day and the third day after surgery.
Rated on a 0-10 scale, with a higher score representing greater satisfaction.
Time frame: On the first day,the second day and the third day after surgery.
Satisfaction score of surgeons on the first day,the second day and the third day after surgery.
Rated on a 0-10 scale, with a higher score representing greater satisfaction.
Time frame: On the first day,the second day and the third day after surgery.
Both the liposomal bupivacaine group and the ropivacaine group were subjected to ACB and iPACK block. Area under the pain intensity-time curve within 72 hours after the first postoperative dose(PI-AUC72)was observed in the three groups.
A smaller PI-AUC72 indicates a longer duration of nerve block.
Time frame: within 72 hours after the first postoperative initiation of drug administration
15-item Quality of Recovery Rating Scale (QoR-15): 24hours, 48hours and 72hours postoperatively
QoR-15 was used to assess five aspects of postoperative recovery quality (physical comfort, physical independence, psychological support, emotion and pain), with higher scores indicating the higher postoperative recovery quality. The lowest score is 0 points, and the highest score is 150 points.
Time frame: at 24 hours, 48 hours and 72 hours postoperative