Objective To explore the efficacy of ultrasound-guided continuous saphenous nerve block ( SNB ) for postoperative analgesia after total knee arthroplasty ( TKA) . Methods Approved by the ethics committee , sixty patients underwent selective TKA in our hospital from March 2016 to May 2016.The patients were randomly divided into either SNB group ( n=30) or femoral nerve block (FNB) group (n=30).Ultrasound-guided SNB or FNB was administered postoperatively , with 5 ml/h of 0.2%ropivacaine continuously infused plus a bonus of 5 ml every 30 min in both groups .The numeric pain rating scale ( NPRS) was used to assess pain intensity at 4, 8, 12, 24, 36, and 48 h after block at rest and during functional exercise .The quadriceps muscle strength at 4, 8, 12, 24, 36, and 48 h was recorded .The usage of pethidine postoperatively , the incidence of opioid related adverse effects , and patient satisfaction scores at 48 h were also recorded . Results The pain scores at rest and during active and passive functional exercise at 4, 8, 12, 24, 36, and 48 h had no significantly differences between the two groups (P>0.05).The quadriceps muscle strength at 8, 12, 24, and 36 h in the SNB group was higher than that in the FNB group ( Z=-3.637, P=0.000; Z=-4.618, P=0.000;Z=-4.461, P=0.000;Z=-3.908, P=0.006).The usage of pethidine postoperatively was 13.3% (4/30) in the SNB group and 16.7%(5/30) in the FNB group, without significant difference (χ2 =0.000, P=1.000).The incidence of opioid related adverse effects was 10.0% (3/30) in the SNB group and 6.7% (2/30) in the FNB group, without significant difference (χ2 =0.000, P=1.000).The patient satisfaction score at 48 h was (8.7 ±0.8) points in the SNB group, which was significantly higher than the FNB group [(6.1 ±0.7) points, t=13.517, P=0.000]. Conclusion Both SNB and FNB can offer effective analgesic results after TKA , but SNB has less influence on quadriceps muscle strength than FNB .Therefore , SNB group are superior to FNB group in patients ’ early activity and motor function recovery .%目的：探讨超声引导连续隐神经阻滞（ saphenous nerve block ，SNB）对全膝关节置换术（ total knee arthroplasty ， TKA）后镇痛效果的影响。方法经我院伦理委员会批准，选择2016年3～5月我院择期TKA 60例，采用随机数字表将患者随机分为隐神经组（n＝30）与股神经组（n＝30）。2组操作均在术后进行，持续输注0．2％罗哌卡因PCA背景量5 ml／h，患者自控镇痛剂量每次5 ml，锁定时间30 min，使用时间48 h。采用数字疼痛评分法（ numeric pain rating scale ，NPRS）评估阻滞后4、8、12、24、36、48 h静息和运动时的疼痛程度，同时记录股四头肌肌力，比较2组患者术后哌替啶使用率、阿片类药物不良反应发生率和48 h患者满意度评分。结果2组阻滞后4、8、12、24、36、48 h静息痛与运动痛评分无明显差异（ P＞0.05）。隐神经组阻滞后8、12、24、36 h股四头肌肌力明显高于股神经组（Z＝－3．637，P＝0．000；Z＝－4．618，P＝0．000；Z＝－4．461，P＝0．000；Z＝－3．908，P＝0．006）。隐神经组术后哌替啶使用率13．3％（4／30），股神经组为16．7％（5／30），差异无统计学意义（χ2＝0．000，P＝1．000）。隐神经组术后阿片类药物不良反应发生率为10．0％（3／30），股神经组为6．7％（2／30），差异无统计学意义（χ2＝0．000，P＝1．000）。 SNB组48 h患者满意度评分为（8．7±0．8）分，明显高于FNB组（6．1±0．7）（t＝13．517，P＝0．000）。结论2种阻滞方法均能为TKA术后提供有效镇痛，但与连续FNB相比，连续SNB对股四头肌肌力影响较小，可促进患者早期活动和患肢功能恢复。
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