Effect of two concentrations of ropivacaine on rebound pain after retreat of iliac fascia block in patients undergoing total knee arthroplasty：a prospective, double-blind randomized controlled trial
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Objective: The aim of this research was to evaluate the effect of two different local anesthetic concentrations on rebound pain following Fascial Iliac Compartment Block (FICB) retreat in patients undergoing total knee arthroplasty (TKA). Method: 48 patients undergoing unilateral TKA under elective general anesthesia were randomly divided into two groups (n=24): the 0.1% ropivacaine group (Group A) and the 0.3% ropivacaine group (Group B). Before anesthesia, two groups of patients underwent a single ultrasound guided- FICB above the inguinal ligament, with 40 mL of 0.1% or 0.3% ropivacaine; all patients underwent perioperative multimodal analgesia. The first outcomes are incidence and degree of postoperative rebound pain; secondary outcomes are remedial analgesia rate within 48h postoperatively, opioid consumption from 0-24 h and 24-48 h postoperatively, NRS scores and muscle strength scores at rest and exercise at 24h and 48h postoperatively, and intravenous serum concentrations of interleukin-6 (IL-6) and tumor necrosis factor α(TNF-α) before surgery and at 24 and 48 h after surgery. Results: In group A , the incidence of postoperative rebound pain was lower ( P <0.01), and the degree of rebound pain was milder ( P <0.01). The remedial analgesia rate was lower within 48 h after surgery ( P <0.05); opioid consumption was lower at 0-24 h after surgery ( P <0.01); the postoperative NRS score at 24 h was lower ( P <0.01), while the muscle strength score was higher ( P <0.01); There was no statistically significant difference in intravenous serum concentrations of IL-6 and TNF-α before surgery, and at 24 and 48 h after surgery. Conclusion: The incidence of rebound pain after the resolution of FICB with low-concentration ropivacaine was lower, and low-concentration ropivacaine FICB was more suitable for multimodal analgesia in TKA patients.
