Objective To compare the stress and analgesic effects of continuous femoral nerve block (CFNB) and patient con‐trolled intravenous analgesia (PCIA) applied in total knee replacement .Methods Sixty‐eight patients with knee osteoarthritis who underwent total knee replacement in our hospital from December 2012 to December 2014 were selected and were randomized into CFNB group and PCIA group by the random number table method ,34 cases in each group .The changes of visual analogue scale (VAS) ,postoperative 24 h fasting blood glucose ,C‐reactive protein (CRP) ,white blood cell count (WBC) ,serum cortisol and other stress index levels ,the incidence of postoperative adverse reactions and recovery of affected limb function were compared between the two groups at different time points after total knee replacement .The two groups of patients were followed up for 1 year in be‐havior period ,and the function of knee joint was evaluated .Results The VAS scores of CFNB group at postoperative 6 ,12 ,24 ,36 and 48 h were significantly lower than those of PCIA group(t=2 .662 ,9 .957 ,5 .577 ,7 .550 ,2 .627 ,P<0 .05) .The levels of blood glucose ,CRP ,WBC and cortisol in CFNB group were significantly lower than those in PCIA group (t= 3 .490 ,10 .139 ,3 .273 , 2 .739 ,P<0 .05) .The incidence of adverse reactions in CFNB group (8 .82% ) was significantly lower than that in PCIA group (38 .24% ) (χ2 =8 .173 ,P<0 .05) .The time in bed of CFNB group was significantly shorter than that of PCIA group (t=4 .096 , P<0 .05) .The times of daily walking was significantly more than that of the PCIA group (t=2 .803 ,P<0 .05) .Conclusion The effect of CFNB applied in analgesia after total knee replacement is better than that of PCIA .The postoperative stress response and adverse reactions are fewer .Patients can get off bed and have exercise earlier ,and postoperative knee function recovery is faster .%目的：比较连续股神经阻滞（CFNB）与静脉自控（PCIA）用于全膝关节置换术的应激及镇痛效果。方法选取该院2012年12月至2014年12月因膝关节骨关节炎而行全膝关节置换术的患者68例，根据随机数字表法将患者分为CFNB组和PCIA组，每组各34例。比较两组患者全膝关节置换术后各时间段视觉疼痛评分（VAS）、术后24 h血糖、C反应蛋白（CRP）、白细胞计数（WBC ）、血清皮质醇等应激指标水平变化、术后不良反应发生率及患肢功能恢复效果，对两组患者术后进行为期1年随访，以及膝关节功能评估。结果 CFNB组患者术后6、12、24、36、48 h时间段VAS评分较PCIA组显著较低，差异均有统计学意义（t＝2．662、9．957、5．577、7．550、2．627，P＜0．05）；CFNB组血糖、CRP、WBC、皮质醇水平较PCIA组均显著较低，差异均有统计学意义（t＝3．490、10．139、3．273、2．739，P＜0．05）；CFNB组不良反应发生率为8．82％，较PCIA组的38．24％显著降低，差异有统计学意义（χ2＝8．173，P＜0．05）；CFNB组卧床时间较PCIA组显著缩短，差异有统计学意义（t＝4．096，P＜0．05）；CFNB组每日行走次数较PCIA组显著较多，差异有统计学意义（t＝2．803，P＜0．05）。结论 CFNB用于全膝关节置换术后的镇痛效果较PCIA更好，术后应激反应和不良反应减少，患者能尽早下床进行锻炼，术后膝关节功能恢复更快，值得临床推广应用。
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