Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management1993-65082687-1394Eco-Vector11118410.17816/RA111184Research ArticleCombination of peripheral blocks as a part of enhanced rehabilitation in total knee replacement: a prospective comparative open randomized studyManevskiyAndrey A.<p>MD, Cand. Sci. (Med.); department assistant, head of the department</p>a_manevskiy@mail.ruhttps://orcid.org/0000-0002-8776-1368SviridovSergey V.<p>MD, Dr. Sci. (Med.), Professor, head of the department</p>sergey.sviridov.59@mail.ruhttps://orcid.org/0000-0002-9976-8903BuilovaTatiana V.<p>MD, Dr. Sci.(Med.), Associate Professor</p>tvbuilova@list.ruhttps://orcid.org/0000-0003-0282-7207TorpudzhiyanMargarita A.<p>clinical resident</p>margo-08.01@yandex.ruhttps://orcid.org/0000-0002-7642-2918BorzovaNatalia U.<p>anesthesiologist-resuscitator</p>borzovan@mail.ruhttps://orcid.org/0000-0002-8068-9674TarbushkinAnton A.<p>MD, Cand. Sci. (Med.)</p>dr.tarbushkin@gmail.comSerebryakovAnton B.<p>MD, Cand. Sci. (Med.)</p>anton.serebryakov@yandex.ruhttps://orcid.org/0000-0002-5621-1654AskerovSamir M.<p>graduate student</p>samir2803@mail.ruhttps://orcid.org/0000-0002-0169-234XDzeytovaBella M.<p>clinical resident</p>dzeytovab@bk.ruhttps://orcid.org/0000-0002-2118-7279National Medical Research Center «Medical and Rehabilitation Center»Pirogov Russian National Research Medical UniversityLobachevsky National Research State University of Nizhny Novgorod200120231632052170310202225102022Copyright © 2022, Eco-Vector2022<p><strong><em>BACKGROUND:</em></strong> The patients recovery after total knee replacement (TKR) is long and is associated several potentially serious complications. The optimal solution to this problem is the introduction of regional blocks of the lower limb into anesthesiologic practice, which can contribute to enhanced rehabilitation and fewer complications.</p>
<p><strong><em>AIM: </em></strong>To perform a prospective comparative analysis of the anesthesia outcomes of patients who received a combination of prolonged femoral nerve blockade (CFNB) with catheter insertion and infiltration between the popliteal artery and capsule of the knee (IPACK), with the results in patients receiving prolonged epidural analgesia (PEA) as postoperative analgesia for TKR.</p>
<p><strong><em>MATERIALS AND METHODS: </em></strong>Eighty patients were included and distributed according to the required planned surgical intervention (TKR). The duration of the inclusion period was 3 months (from March to May 2022). Patients were observed up to 48 h after surgery, with control points every 8 h. The patients were divided into two groups: group 1 (PEA, <em>n</em>=40) underwent subarachnoid anesthesia in combination with PEA, and group 2 (<em>n</em>=40) underwent subarachnoid anesthesia as a combination of CFNB and IPACK. To compare the groups, the following main indicators were used: severity of pain syndrome (visual analog scale [VAS], from 0 to 10 cm), muscle strength on the Medical Research Council (MRC) scale, duration of patients stay in the intensive care unit, duration of hospitalization, and presence of postoperative complications.</p>
<p><strong><em>RESULTS: </em></strong>The highest average score for VAS was recorded at 32 h in group 1, and it was 3.6 cm. The lowest average score for VAS (1.11.2 cm) was noted in the first 8 h and after 48 h in group 1. In group 2, this value was 0.91.5 cm in the first 16 h, and at 48 h, the pain syndrome was more pronounced in group 2, making up 2 cm on VAS. Compared with the PEA group, the CFNB group had statistically higher values of the indicators of the motor strength of the leg muscles on the MRC scale at all stages of the study. The PEA group stayed in the intensive care unit statistically significantly longer than the PBN group: 210 (189260) and 180 (154185) min, respectively (<em>p</em> 0.001).</p>
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