YU Qingqing 1 , TANG Yingchao 2 , FU Haiyu 3 , JIANG Li 2 , SONG Benjing 2 , WANG Wei 2 , XIE Qingyun 2 , CHEN Song 2
  • 1. College of Medicine, Southwest Jiaotong University, Chengdu Sichuan, 610031, P. R. China;
  • 2. Department of Orthopedics, the General Hospital of Western Theater Command, Chengdu Sichuan, 610083, P. R. China;
  • 3. Department of Anesthesiology, the General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P. R. China;
CHEN Song, Email: chensongchinese@163.com
Fascia iliac compartment block; total knee arthroplasty; Tourniquet-related pain
10.7507/1002-1892.202505024
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Objective  To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). Methods A prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups (n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gental, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant differences between the two groups (P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. Results  In the trial group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels (P<0.05), while resting VAS scores showed no significant changes. Except for resting VAS at 6 hours, movement VAS scores at 48 hours, and BCS comfort score at 48 hours (P>0.05), the experimental group showed significantly better outcomes than the control group in terms of resting VAS, movement VAS, Ramsay sedation scores, and BCS comfort scores at all other time points (P<0.05). No significant differences were found in Bromage motor block scores between the groups (P>0.05). The mean tramadol consumption within 48 hours postoperatively was significantly lower in the experimental group [(133.30±14.19) mg] compared to the control group [(172.40±22.29) mg] (t=9.840, P<0.001). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups (χ²=0.154, P>0.05). Conclusion Ultrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.

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