Parecoxib Sodium Preemptive Analgesia PCIA In Joint Arthroplasty Efficacy Of Perioperative Analgesia

Backgroud:People have been keeping looking for better analgesia methods since pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) is severe. Multimodal analgesia and preemptive analgesia is the focus of current research. Multimodal analgesia aims at combining different types of analgesic drugs and analgesia methods so as to relieve pain and reduce the use of single drug. Preemptive analgesia refers to reduce the peripheral and central pain sensitization by blocking noxious stimuli input before injury occurs. Our study was designed based on the concept of multimodal analgesia and preemptive analgesia. We evaluated the effect of parecoxib sodium preemptive analgesia combined with patient-controlled intravenous analgesia (PCIA) on postoperative pain, analgesic use, function recovery, inflammatory and stress response and perioperative safety after TKA and THA.Methods:This was a prospective, randomized, patient and observer blind control study. Thirty-eight patients underwent TKA and twenty-nine patients underwent THA were enrolled in the TKA group and the THA group respectively. In each group, they were randomized into the study group and the control group. The study group received a single40mg dose of parecoxib sodium30minutes before incision,9PM on the operation day and every12hours for two days, along with PCIA morphine. The control group received only PCIA morphine for postoperative pain management. Pain was assessed at rest and during movement using a visual analog scale (VAS). Morphine consumption and joint function were also recorded. As indicators of inflammatory and stress response, body temperature, leukocyte count, hypersensitive C reactive protein (hs-CRP), blood glucose were monitored. And serum interleukin-1β (IL-1β), interleukin-6(IL-6), interleukin-10(IL-10) and tumor necrosis factor-α (TNF-α) were also measured.Results:In patients underwent TKA, VAS both at rest and at movement were improved significantly in the study group, compared with the control group at all the observation points in the48h after surgery (P<0.05). The morphine consumption were significantly reduced in the study group (23.9mg±14.0mg vs.41.2mg±15.6mg,P=0.002) while the active range of motion (ROM) increased significantly at post-operation day (POD)6(81.2°±9.9°vs.72.6°±9.9°, P=0.017). The body temperature and leukocyte count on POD1and POD3, the hs-CRP on POD3and POD6and the blood glucose on POD1were also significantly decreased in the study group. There was no significant difference between the two groups in perioperative blood loss, drainage, blood transfusion rate and hemoglobin. In patients underwent THA, VAS at rest were improved significantly in the study group, compared with the control group at12h and24h (P<0.05). And VAS at movement were improved significantly at12h,24h,36h,48h, POD3and POD4(P<0.05). The morphine consumption were significantly reduced in the study group (11.5mg±5.3mg vs.30.8mg±17.6mg,P=0.001) while the withdrawal of PCIA were significantly earlier (11.5h±5.3h vs.34.3h±14.5h).The body temperature was significantly decreased in the study group on PODl and POD3(P<0.05). There was no significant difference between the two groups in perioperative blood loss, drainage, blood transfusion rate and hemoglobin.Conclusion:The multimodal analgesia regime combining parecoxib sodium preemptive analgesia and PCIA significantly improved postoperative VAS, reduced morphine consumption, increased active ROM and decreased inflammatory response after TKA and THA, without increasing the risks of bleeding and other adverse events.