Objectives: To explore the effect of acupuncture intervention combined with lateral approach sciatic nerve block (LSNB) on postoperative analgesia in patients after total knee arthroplasty (TKA).
Methods: A total of 90 patients scheduled for TKA between May 2022 and May 2024 were selected as the study subjects. They were randomly divided into a control group and an observation group using the sealed envelope method, with 45 patients(one case dropped out in each group)in each group. The control group received LSNB for postoperative analgesia, while the observation group received acupuncture intervention (manual acupuncture stimulation of Taichong [LR3], Kunlun [BL60], Taixi [KI3], Shenmai [BL62] and Sanyinjiao [SP6] on the affected side, and Houxi [SI3], Chize [LU5], Quchi [LI11] and Shousanli [LI10] on the healthy side, 30 min per session, once daily for 7 days) in addition to LSNB. Postoperative rescue analgesic usage and sleep monitoring results were recorded. Resting and passive functional exercise-induced limb pain intensity was assessed using the visual analog scale (VAS) at 2 hours (T0), 6 hours (T1), 24 hours (T2), 48 hours (T3), 72 hours (T4), and 7 days (T5) postoperatively. Recovery quality was evaluated using the 15-item quality of recovery scale (QoR-15) at T0, T5, 1 month (T6), and 3 months (T7) postoperatively. The safety of the analgesic regimens was also assessed.
Results: The frequency of rescue analgesic use and the total dosage consumed were significantly lower in the observation group than in the control group (P<0.05). There were no statistically significant differences between two groups in the sleep latency and N1 sleep stage proportion within 0-12 hours after operation. However, within 12-72 hours postoperatively, the observation group had fewer awakenings, a higher proportion of N3 deep sleep, and higher sleep efficiency than the control group (P<0.05). At T5, VAS scores at rest and during passive functional exercise were significantly lower in the observation group than in the control group (P<0.05). The incidence of adverse reactions was below 10% in both groups, with no statistically significant difference between the two groups . QoR-15 scores were significantly higher in the observation group than in the control group at T5 and T6 (P<0.05).
Conclusions: Compared with LSNB alone, acupuncture intervention combined with LSNB after TKA can reduce the need for rescue analgesia, relieve early postoperative pain, and improve the quality of sleep and postoperative recovery, and is safe.
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