| Background:Total Knee Arthroplasty(TKA)is the most effective treatment for end-stage knee osteoarthritis,which can reduce pain,correct deformities,improve joint function and improve patients’ quality of life.enhanced rehabilitation after surgery(ERAS)recommends that early rehabilitation after TKA can increase the range of motion,walking capacity and stability of the joint,and has a direct impact on long-term surgical outcomes,which is equal to that of surgery.However,moderate to severe pain is often associated with TKA surgery,which is an acute traumatic pain in nature.Although the development of surgery and anesthesia technology has greatly relieved the trauma and pain after TKA surgery,about 50%of patients are still accompanied by relatively severe operative limb pain in the early postoperative period,and 10%-30%of patients have troubling knee pain within 5 years after surgery,which seriously affects postoperative rehabilitation and functional exercise.Therefore,postoperative pain control is a key factor affecting the long-term clinical outcome of TKA.Objective:A randomized controlled trial was adopted in this study.The control group received multi-mode analgesia regimen,and the test groups were combined with Transcutaneous electrical acupoint stimulation(TEAS).The main outcome indexes included activity and resting VAS pain score at 3 and 7 days after surgery and WOMAC function score at 4 weeks after surgery.Combined with the observation of pain threshold and median frequency of surface electromyography of the rectus femoris muscle,the clinical efficacy of TEAS in improving pain and accelerated joint functional rehabilitation after TKA surgery was explored.The effect of this program on reducing the use of postoperative analgesic drugs and the occurrence of related adverse reactions was discussed,as well as the effect mechanism of enhancing postoperative analgesic efficacy and promoting functional rehabilitation.Methods:A total of 100 patients who underwent TKA and met the inclusion criteria in the Department of Arthrology,Wangjing Hospital,China Academy of Chinese Medical Sciences from August 2021 to October 2022 were randomly divided into the experimental group(n=50)and the control group(n=50).The control group was given multimodal analgesia,and the experimental group was combined with TEAS on this basis.The VAS scores and WOMAC scores at different time points after operation were observed in the two groups to verify the clinical efficacy of TEAS in improving postoperative pain and joint function rehabilitation after TKA.The pain threshold and median frequency of rectus femoris surface electromyography were detected to explore the effect mechanism of enhancing postoperative analgesia and accelerating functional recovery.The dosage of postoperative analgesic drugs and the occurrence of postoperative related adverse reactions were recorded,and the effect of reducing the dosage of analgesic drugs and related adverse reactions was evaluated.Results:One case dropped out of the control group and 3 cases dropped out of the experimental group.(1)There was no significant difference in the average course of disease and operation time between the two groups(P>0.05).(2)VAS score at rest:in the two groups,VAS score at rest was lower at 3 days after operation than at 1 day after operation,and lower at 7 days after operation than at 3 days after operation(P<0.05).Compared with the control group,the experimental group was significantly lower at 3 and 7 days after operation(P<0.05).(3)VAS score in active state:compared within the same group,VAS score in the two groups was lower on the 3rd day after operation than on the 1st day after operation,and VAS score in the trial group was lower on the 7th day after operation than on the 3rd day after operation(P<0.05).Compared with the control group,the experimental group was significantly lower at 3 and 7 days after operation(P<0.05).(4)WOMAC score:in the experimental group,WOMAC score at 4 weeks after operation was lower than that at 2 weeks after operation,and WOMAC score at 12 weeks after operation was lower than that at 4 weeks after operation in the two groups(P<0.05).Compared with the control group,the experimental group was significantly lower at 2,4,and 12 weeks after operation(P<0.05).(5)Pain threshold:the pain threshold of the two groups on the 7th day after operation was higher than that before operation(P<0.05).The pain threshold of the experimental group was higher than that of the control group on the 7th day after operation(P<0.05).(6)The median surface electromyography frequency of rectus femoris muscle:the median frequency of the two groups on the 7th day after operation was lower than that before operation(P<0.05).The median frequency of the experimental group was higher than that of the control group on the 7th day after operation(P<0.05).(7)The dosage of opioid analgesics and adverse reactions:the dosage of bucinosine hydrochloride injection in the experimental group was less than that in the control group,and the incidence of nausea and vomiting was lower than that in the control group(P<0.05).Conclusion:Tetras combined with multi-mode analgesia can effectively relieve joint pain in resting and active states after TKA,reduce the psychological burden,improve the quality of rehabilitation,and increase surgical satisfaction.In terms of functional rehabilitation,by enhancing the muscle strength of the rectus femoris muscle,improving the ductility of the tissues around the joint,increasing the tolerance of joint function exercise,and promoting the process of joint function rehabilitation;In terms of analgesic drugs,the use of opioids should be reduced to reduce the occurrence of adverse reactions such as nausea and vomiting,and improve patients’ quality of life.In this study,subjective and objective experimental data were used for evaluation,and further research needs to expand the sample size and enrich the evaluation indicators for more in-depth clinical verification. |
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