The Effect Of Combined Analgesia On Early Stages Of Functional Training After Total Knee Arthroplasty

Objective:To study the combined analgesics for post-TKA and the effect of combined analgesia on early stages of postoperative functional training.Methods:90 subjects with primary osteoarthritis were selected from inpatients in China-Japan Union Hospital of Jilin University from October 2013 to October 2015. Criteria for cases: 1 The diagnosis of knee osteoarthritisis was confirmed by imaging studies and physical examinations.2Rheumatoid arthritis, tuberculosis and other diseases are excluded by laboratory examinations.3The subjects underwent obvious activity limitation in the knee joint and the passive motion degree can reach 100 degree or above, without obvious varus or valgus deformity of the knee joint; 4Among the 90 subjects with nonatopic and no special drug allergy history,37 cases were male, and 53 cases were female; 33 cases of the left knee, 57 cases of the right knee. The selected subjects were randomly divided into 3 groups of 30 patients. All the patients received the total knee arthroplasty. The experimental group was given multi drug combined analgesia regimen(Pethidine + Parecoxib +Flupirtine Maleate),control group 1 were given Pethidine and Parecoxib,and control group 2 were given Flupirtine Maleate.The following clinicaldata were documented: relief of pain 、 daily static and dynamic VAS score、HSS score and the max active flexion angle at 3 days, 7 days and12 days after operation and fever, rash, vomiting and other adverse reactions.Results:There were significant differences(P<0.001) in postoperative static and dynamic VAS scores between the multi drug combined analgesia group and the two control groups, while the tendency to daily average static VAS score between the combined analgesia group and control group 1 was similar. The changing tendency of daily average dynamic VAS score starts to rebound on postoperative day 2-3. There were significant differences(P<0.001) in the HSS score and the max active flexion angle compared to the two control groups, and the average level of the multi drug combined analgesia group was higher, but the changing trend was similar. The number of adverse events occurred more frequently in combined analgesia group.Conclusion:Three therapies all could effectively relieve the static pain after total knee arthroplasty. For dynamic pain, combined analgesia treatment showed evident effect on the rehabilitation of ROM. The application of combined analgesia enabled the subjects to achieve the best recovery effect on the knee function sooner after total knee arthroplasty, but thenumber of adverse reactions increased.