Clinical Observations Of Multimodal Postoperative Analgesia In Total Knee Arthroplasty

Objective: To compare the clinical effect of three types of multimodal analgesia on total knee arthroplasty.Materials and methods:Total of 60 paitients were selected including 19 males and 41 females ASA ?-?,Who scheduled to undergo electively unilateral Total Knee Arthroplasty in our hospital(Dalian Municipal Second People,s Hospital)from August2015 to December 2015.All paitents were informed consent,made anesthesia with combined spinal epidural analgesia by the same anesthesiologist,and performed the operation by the same group of surgeons.Postoperative analgesia plan: group A,a dose of 1.5 mg morphine was administered by epidural catheter and connected peripheral patient-controlled intravenous analgesia pump postoperatively;group B,as well as group A,plus cocktail periarticular injection intraoperatively,;group C,as well as group A,plus 100 mg indomethacin rectal suppository was administered at postoperative4 h.Compared postoperative analgesia effect and the incidence of postoperative complications in the three groups of patients.All of paitients were observed within 48hours:(1)General information of patients.(2)The information data with anesthesia and surgery.(3)Record the visual analogue pain score(VAS)with rest and activity,and Ramsay score at postoperative 4h,6h,8h,24 h,48h.(4)Times of the durg deliverycontrolled by the pump of the patient-controlled intravenous analgesia.(5)The dose of pethidine which were applicated for each group within 48 h after TKA.(6)The total drainage volume of drainage tube after TKA.(7)The first time off of bed.(8)The incidence rate of postoperative complications.(9)Satisfatory rate of postoperative analgesia(gross satisfaction scales,GSS score).The experimental results were analyzed by social science statistical package SPSS16.0,measurement data was used by Least-Significant Difference test,the multiple mean was compared in three groups,with a mean ± standard deviation said;enumeration data and the multiple rate was copared by chi-square test,P<0.05 for the difference was statistically significant.Results:(1)General datas in patients of three groups as well as the information data of anesthesia and surgery,have no statistically significant difference.(2)VAS with rest and activity:group B were lower than group C and group A at 4h and 6h postoperatively,P<0.01;group C were lower than group B and group A at 8h and24 h postoperatively,P<0.01;group C and group B were lower than group A at 6h?8h and 24 h postoperatively,P<0.01.Ramsay score:group B was higher than group C and group A at 4h postoperatively,P<0.01;group C and group B were higher than group A at6 h 8h and 24 h postoperatively,P<0.05.(3)Times of the durg delivery controlled by the pump of the patient-controlled intravenous analgesia.:group C and group B were less than group A,P<0.05;Compared group B with group C,P>0.05,there was no statistically significant difference.(4)The dose of pethidine which were applicated for each group within 48 h after TKA.:group C and group B were less than group A,P<0.05;Compared group B with group C,P>0.05,there was no statistically significant difference.(5)The total drainage volume of drainage tube after TKA.:group B and group C were bigger than group A,P < 0.05;Compared group B with group C,there was no statistically significant difference.(6)The first time off of bed:group C was shorter than group B,and group B was shorter than group A,P<0.05.(7)The incidence rate of postoperative complications:group C and group B were less than group A,P<0.05;Compared group B with group C,there was no statistically significant difference.(8)Satisfatory rate of postoperative analgesia(gross satisfaction scales,GSS score):group C and group B were better than group A,P<0.05;Compared group B with group C,there was no statistically significant difference.Conclusion:The multimodal method that a dose of 1.5mg morphine administered by epidural catheter,connected peripheral patient-controlled intravenous analgesia and combined with indomethacin suppositories is worthy of promotion in postoperative analgesia for TKA.