Ultrasound-Guided Femoral Nerve Block with Esketamine Adjuvant for Postoperative Analgesia in Total Knee Arthroplasty-A Randomized, Double-Blind, Controlled Trial.

Abstract

<h4>Objective</h4>To evaluate the analgesic effect and complication profile of ultrasound-guided femoral nerve block (FNB) with esketamine as an adjuvant to ropivacaine in patients undergoing total knee arthroplasty (TKA).<h4>Methods</h4>This was a prospective, randomized, double-blind, controlled clinical trial. Sixty patients undergoing elective TKA were randomized 1:1 into Group A (n=30) and Group B (n=30). Group A received 20 mL of 0.25% ropivacaine for ultrasound-guided FNB, whereas Group B received 20 mL of 0.25% ropivacaine combined with 0.5 mg/kg esketamine for identical FNB. All patients received combined general anesthesia and FNB. Postoperative visual analogue scale (VAS) pain scores at 2, 4, 6, 8, 10, and 12 h, 24-hour sufentanil consumption, incidence of postoperative nausea and vomiting (PONV), and other adverse events were documented.<h4>Results</h4>Baseline characteristics including age, height, weight, ASA physical status, gender composition, and operation duration were comparable between the two groups (all P>0.05). The VAS score at 10 h postoperatively was significantly lower in Group B than in Group A (P=0.026), while no significant differences were detected at other time points (all P>0.05). Total 24-hour sufentanil consumption was significantly reduced in Group B compared with Group A (P<0.001). The incidence of PONV did not differ significantly between the two groups (P=0.467).<h4>Conclusion</h4>Ultrasound-guided femoral nerve block (FNB) combined with esketamine and ropivacaine relieved postoperative pain at 10 hours and reduced opioid consumption in patients undergoing total knee arthroplasty (TKA), with no increase in adverse events. This regimen can serve as a safe analgesic option for TKA patients.

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