The Influence Of Programmed Multi-mode Analgesia On Cytokine And Early Rehabilitation In TKA Patients

ObjectiveTo investigate the influence of peri-operative programmed multi-modal analgesia on plasma substance P (Substance P,SP), interleukin-6 (IL-6), and postoperative early rehabilitation in (total knee arthroplasty, TKA) patients.Method60 cases of end-stage osteoarthritis patients undergoing Total Knee Arthroplasty Surgery were randomly divided into two groups:the programmed multi-modal analgesia group (experimental group of 30 patients) and postoperative multi-modal analgesia group (control group of 30 patients). Group A of programmed multi-modal analgesia (1.Preoperative 2d:Celecoxib 0.2g Po bid;2.Preoperative lh:Parecoxib 40mg iv;3.The recovery of intravenous anesthesia, PCIA pump to maintain 48 h; 4.Postoperative 6h after intravenous, Parecoxib 40mg once again, 1d and 2d postoperative intravenous Parecoxib 40 mg, bid;5.Local incision intermittent ice 24h from preoperative;6.1d from postoperative celecoxib 0.2g, Po, Bid until Patients discharged from hospital. Group B of postoperative multi-modal analgesia (1.Preoperative 1h:NS 40mg iv;2.using PCIA pump from recovery of intravenous anesthesia to postoperative 48h;3.Postoperative 6h after intravenous, NS 40mg once again, 1d and 2d postoperative intravenous NS 40 mg, bid; 4.Local incision intermittent ice 24h from preoperative; 5.1d from postoperative celecoxib 0.2g, Po, Bid to Patients discharged from hospital). Blood samples were collected at following time points:entering the operating room before anesthesia performed (H1), post-operation immediately (H2),6h (H3), 12h (H4),24h (H5), and the levels of cytokines IL-6, plasma SP were measured; The concentration of Plasma SP and the concentration of serum IL-6 were measured by Elisa (enzyme-linked immunosorbent assay);The patients’ pain visual analog scale (VAS) at six time points after operation; Preoperative and postoperative 3 days,2 weeks of pain and observe knee function recovery by HSS.ResultAt 6h,12h and 24h postoperatively, SP in the plasma were (103.38±8.25,121.74±8.75, 101.61±6.13)ng/ml in the PEPMA group, while (112.87±6.02,134.44±7.05,108.91±6.47)ng/ml in the POMA group, associated with statistical significance in difference between the two groups at each time point (P<0.01). Likewise, IL-6 in the serum existed (48.43±10.12,61.84±12.53, 43.31±11.13)pg/ml in the PEPMA group, whereas (67.31±12.03,93.24±36.51,61.21±10.39)pg/ml in the POMA group respectively, with significant difference between the two groups (P<0.01). Additionally, VAS scores in the PEPMA group were significantly lower than those in the POMA group (P<0.01). Furthermore, HSS scores in the PEPMA group were significantly higher than the POMA group B at 3 days postoperatively (P<0.01).ConclusionMulti-mode programmed analgesia (PEPMA) in TKA patients can reduce the levels of plasma SP and IL-6, relief peri-operative pain more completely. So patients can do functional exercise as early as possible, that contributing to knee functional recovery early, improving patient satisfaction for TKA surgical approach.