| At present,the insufficient treatment of postoperative pain is still a common and unresolved clinical problem.In the acute phase of total knee replacement and total hip replacement,surgical trauma often lead to obvious severe postoperative pain,while severe postoperative acute pain also increases the risk of postoperative chronic pain.Diabetes or hyperglycemia can aggravate the intensity of postoperative pain and increase the demand for postoperative analgesic drugs,which are the risk factors for the aggravation of acute and chronic postoperative pain.At present,in the clinical work,the usage and dosage of analgesics used in diabetic patients during the perioperative period can not be accurately distinguished from non-diabetic patients,as a result,there are still many urgent problems to be solved in the management of postoperative acute pain and the prevention of chronic acute pain in patients with diabetes.Therefore,this experiment and the follow-up study will provide a certain clinical basis for diabetic patients to reduce the severity and incidence of postoperative acute and chronic pain,and provide reference for the selection of postoperative analgesia for diabetic patients.ObjectiveTo explore the difference of postoperative pain after primary total knee or hip replacement between diabetic and non-diabetic patients.MethodsWe collected 62 patients with osteoarthritis who were scheduled to undergo primary total knee or hip replacement.They were divided into two groups:diabetic group(group D,n=31)and non-diabetic group(group ND,n=31).Patients in both groups underwent primary total hip or knee replacement under combined spinal-epidural anesthesia.After operation,wireless analgesia system was used for intelligent management.PCIA formula:2ug/kg sufentanil,total 120ml,continuous dose 1.5ml/kg,single compression 1.5ml,interval 15min.(1)Record the mechanical tenderness threshold(g)before operation,at the end of operation,3h,6h,24h,48h and 72h after operation.(2)Visual analogue scale was used to record the pain score before operation,at the end of operation,3h,6h,12h,24h,48h,72h after operation during rest and exercise.(3)Consumption of sufentanil and adverse reactions were recorded at 3h,6h,12h,24h,48h and 72h after operation in PC A.(4)Detect and record the concentration of TNF-α,IL-6 and IL-10 in venous blood before and 3h after operation.(5)The patients were followed up by telephone at 1st,3th,and 6th months after the operation,and the incidence of chronic pain after the operation was inquired and recorded.ResultsCompared with ND group,the mechanical withdrawal threshold before operation,at 3h,6h and 12h after operation in group D was significantly lower(P<0.05).Compared with ND group,the resting VAS of patients in group D at 3h,12h,24h and 48h after operation and the exercise VAS at 6h,12h,24h and 48h after operation were significantly increased(P<0.05).Compared with ND group,the consumption of sufentanil in group D increased significantly at 3h,6h and 72h after operation(P<0.05).There was no significant difference in serum IL-6,TNF-α and IL-10 levels before and 3h after operation between the two groups(P>0.05).At 6th months after surgery,the incidence of postoperative chronic pain in group D was significantly higher than that in group ND(P<0.05).The intensity of chronic postoperative pain in group D was higher than that in group ND at 1st and 6th months after surgery(P<0.05).ConclusionsCompared with non-diabetic patients,the severity of acute pain after total hip or knee replacement in diabetic patients and the incidence and severity of postoperative chronic pain are higher than those in non-diabetic patients.Therefore,diabetic patients undergoing primary total hip or knee replacement may need a larger dose of analgesics to achieve effective postoperative analgesia and effective analgesic measures to reduce the incidence and intensity of chronic postoperative pain. |
PDF Full Text Request