Effect Of COX-2Inhibitors In Preemptive Analgesia Of Total Knee Arthroplasty For Postoperative Pain And High-Sensitivity C-Reactive Protein

OBJECTIVE:To observe the clinical efficacy of COX-2Inhibitors for perioperative management of pain in Total Knee Arthroplasty(TKA).METHODS:60patients(mean age67y,55to76, male13, female47) undergoing unilateral TKA were randomly divided into two groups,30patients in study group were given oral Celecoxib(400mg)2hours preoperative, oral200mg postoperative and200mg Bid extend to14d postoperatively;30patients in control group were given Celecoxib200mg Bid postoperatively. All patients were operated under epidural anesthesia, received "cocktail" analgesia(Ropivacaine200mg+Morphine5mg+Ketorolac30mg+Epinephrine0.3mg+normal saline) in the capsule behind the knee joint, around the medial and lateral collateral ligament, quadriceps extensor mechanism, patellar tendon, and the fat and subcutaneous tissue intraoperatively. Morphine was used as adjuvant. Outcome measures:(1)Visual Analogue Scale(VAS) at resting time points of12h.24h、2d.3d.5d.7d.14d, and VAS at moving time points of3d.5d.7d、14d;(2)The Range of Motion of Knee Joint(ROM) at each time point of1d.2d.3d.5d.7d.14d and Time of knee flexion to90°.(3)Hs-CRP Value were recorded preoperatively and at time point of1d、3d.5d.7d.14d.90d.(4)Hospital for Special Surgery Knee Score(HSS) were recorded at lmonth and3month.(5)Total opioid consumption and adverse reactions in48h were recorded. Statistical software SPSS20.0were used for data analysis, data between two groups were analyzed by independent sample t test, inspection stand were P=0.05.RESULTS:①There were significant difference of VAS(at rest) between two groups at12h,24h,2d,3d, and5d after arthroplasty (P<0.05),but no significant difference at7d (P>0.05).There were no significant difference of VAS(at motion) between two groups after operation.②Preoperative Hs-CRP has no significant difference between two groups (P>0.05), but postoperative Hs-CRP of study group has significantly reduced compared with control group in14days (P<0.05), there were no significant difference in two groups after1month follow-up (P>0.05)③Compared with control group, the ROM of study group has significantly improved in14d after arthroplasty (P<0.05),but there were no significant difference in two groups after1month follow up (P>0.05). The time of knee flexion to90°has significantly reduced (P<0.05).There were no significant difference of Hss between two groups at1month and3month (P>0.05)④Total opioid consumption and adverse reaction in the study group were significant reduced compared with control group (P<0.05)CONCLUSION:①Preemptive analgesia of COX-2inhibitors can significantly mitigate pain during rest and improve the activity of knee joint in the early stage, but not the pain during motion and the activity in the forward stage.②Preemptive analgesia of COX-2inhibitors can significantly reduce the release of inflammatory cytokines, improve the degree of tissue inflammation, and mitigate the Hs-CRP level.③Preemptive analgesia of COX-2inhibitors can reduce the consumption of opioid and the incidence of adverse reactions.