The Clinic Research Of Perioperative Multimodal Analgesia For Total Knee Arthroplasty

Background: Total knee arthroplasty has become an effective methods of treat the terminal stage of knee diseases. Some studies showed that 90% of the patients suffered moderate or severe pain after the operation. Many studies suggested that perioperative administration of multimodal analgesia might reduce the pain during the early postoperative period in patients.Objective: The goal of this study is to evaluate the method and the effect of multimodal analgesia during perioperative.Methods: Sixty ASA class I-II patients, aged 50-80 yr, diagnosed knee osteoarthritis, undergoing total knee arthroplasty, were included in this study. They were randomly divided into three groups. Group P patients (n=20) did not administrative of Celecoxib capsules 2ds before operative and not inject of multimodal analgesia during operation, but received patient controlled analgesia postoperative; Group PMP patients received Celecoxib capsules 2ds before operative, multimodal analgesia during operation and received patient controlled analgesia postoperative; Group PM patients received Celecoxib capsules 2ds before operative and multimodal analgesia during operation but did not receive patient controlled analgesia postoperative. The consumption of patient-controlled analgesia was measured at different time-points during the twenty-four hours postoperative period and the patient's overall analgesic consumption was measured and converted to morphine equivalents to allow for comparison. Postoperative visual analog scales(VAS) for pain and satisfaction, VAS for pain during passive activity postoperative 2 day and 3 day, the patient satisfaction, the verbal rating scale scores of the overall pain intensity and all the side effects, the Ramsay sedation score, the volume of drainage, the vary of Hb and Hct, functional rehabilitation and scores according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were recorded.Results: (1) The VAS scores, 2-8h for pain at rest, the overall pain intensity and the VAS for pain during passive activity postoperative 2 day and 3 day were significantly lower in Group PMP than in Group P(P<0.05); the VAS scores, 2-8h for satisfaction, the GSS and the degree of passive activity 2 day and 14 day after operative were significantly higher in Group PMP than in Group P(P<0.05).(2) The Group PMP had a significantly lower consumption of PCA 2h-12h after operation and had a significantly lower overall requirement for patient-controlled analgesia over the first twenty-four hours after surgery (p <0.05) compared with the Group P (P<0.05); but there was no difference in the overall analgesic consumption in morphine equivalents between the two patient groups (P>0.05)(3 ) The VAS scores, 2h-8h for pain at rest, the overall pain intensity and the VAS for pain during passive activity postoperative 2 and 3 days were significantly lower in Group PM than in Group P(P<0.05); the VAS scores, 2-8h for satisfaction, the GSS and the degree of passive activity 2 day and 14 day after operative were significantly higher in Group PM than in Group P(P<0.05).(4) The VAS scores all time-point for pain and for satisfaction at rest, the overall pain intensity, the GSS and the VAS for pain during passive activity postoperative 2 and 3 days were significantly lower in Group PM than in Group P(P<0.05); the VAS scores, 2-8h for satisfaction, the GSS and the degree of passive activity 2 day and 14 day after operative were similarly between Group PM and Group P(P>0.05).The Group PM had a significantly lower overall requirement for morphine over the first twenty-four hours after surgery compared with the Group P and Group PMP (P<0.05).(5) There was no difference in the Ramsay sedation score, the VAS scores, 2 day and 3 day for pain at rest, the volume of drainage, the vary of Hb and Hct, the degree of passive activity 6 weeks after operative ,the WOMAC and diameter vary of the limb among the three Groups.(6) The incidence of nausea and vomit were lower in Group PM than in Group P(P<0.05); and the incidence of urine retention was comparable in the two groups.(7) The incidence of nausea , vomit and urine retention in Group PM is less than those in Group PMP and Group P.Conclusion: (1) Celecoxib capsules combine cocktail multimodal analgesia can reduce the overall pain intensity , PCA comsumption and enhance the GSS.(2) Celecoxib capsules combine cocktail multimodal analgesia make PCA unnecessary and it will reduce the side effects of PCA, such as nausea , vomit and urine retention, and it will not add the drainage.(3) Celecoxib capsules combine cocktail multimodal analgesia can improve the range of passive activity 2d-14d postoperative, and advance rehabilitation. But the range of passive activity 6 weeks postoperative and the WOMAC 3 months postoperative were not different.