| Objective: To study the analgesic effect and early functional recovery of knee joint after total knee arthroplasty with two kinds of cocktail formulas.Methods:In this study,68 patients were selected from May 2014 to June 2015,with a total of 10 males and 58 females.All patients were treated with primary total knee arthroplasty(TKA)for osteoarthritis(OA).Record: age,sex,weight;Preoperative VSA score was performed for patients with resting and activity state according to the visual analogue pain score criteria;The KSS score of knee joint was evaluated according to the American knee society score.All 68 patients were randomly divided into the study group and the control group,each group with a total of 34 cases,according to the difference of "cocktail" analgesic formula in total knee arthroplasty.3 days before the surgery,All patients were given celecoxib 200 mg,bid.The study group(A group): Ropivacaine 225 mg,ketorolac ammonia butyl alcohol three 30 mg,morphine 5mg and adrenaline 0.3mg mixed liquid with saline to 100ml;the control group(B group): Ropivacaine 225 mg,adrenaline 0.3mg,mixed liquid with saline to 100 ml.The injection site includes: knee joint capsule,medial and lateral ligaments of knee joint,femoral quadriceps tendon,patellar ligament,tendon cut part of patella retinacula,patella retinacula,subcutaneous tissue.The 2/5 of the total amount of the drug solution was injected into the posterior capsule after the osteotomy and tissue balance were completed.The remaining 3/5 was injected into the other tissues of the knee before closing the incision.The duration of surgery was recorded for all the patients,and a negative pressure drainage tube was placed in the knee joint cavity of the two groups of patients after surgery.Drainage tube was moved after 24 h.The two groups were treated with continuous ice wrapped around the knee joint incision 24 h.Subcutaneous injection of low molecular weight heparin 4100 IU of anticoagulation for 2 weeks and conventional anti infective was ferformed.Celecoxib 200 mg were oralled from the first day after surgery.If the analgesic effect of oral medication is not ideal,then tramadol 100 mg intramuscular injection treatment was ferformed.Use the number of tramadol records within 48h;Two groups of postoperative side effects such as nausea,vomiting,skin itching and respiratory depression;The differences of VAS scores between the two groups were recorded and compared with the 8h,16 h,24h,32 h,40h,48 h in the resting and activity state;The difference of intra articular cavity flow rate in 24 h after surgery to evaluate the risk of postoperative bleeding;The KSS score was used to record the clinical and functional at 2 weeks after surgery.Results:1 Analysis of the basic data of patients: A group had 4 males and 30 females,aged from 53 to 75 years old,the average(61.58±11.27)years of age,body weight the average(66.43±7.15)kg.B group had 6 males and 28 females,aged from 54 to 73 years old,the average(62.6±10.40)years of age,body weight the average(67.24±6.37)kg.Operation time: A group(101±8.56)min;B group(101±8.56)min.The sex ratio,weight,age,duration of operation of the two groups were not statistically significant,P >0.05,to ensure that the other data in the two groups were comparable.2 VAS score at rest and after activity: Before surgery,all patients were evaluated with VAS score at rest and after activity.Statistics analysis results: preoperative study group(A group)and control group(group B)resting state VAS score were 6.52±0.34,6.41±0.33;VAS score after activity 8.52±0.39,8.41±0.42,there was no significant difference,P >0.05,comparable.Group A 8h,16 h,24h,32 h,40h,48 h of resting VAS score were:1.89±0.36,2.63±0.31,2.98±0.43,3.12±0.44,2.71±0.32,3.01±0.31;8h,16 h,24h,32 h,40h,48 h VAS scores after activity were:5.65±0.40,5.72±0.40,5.90±0.39,6.16±0.43,5.47±0.39,5.39±0.42.Group B 16 h,24h,8h,32 h,40h,48 h of resting VAS score were:2.14±0.39,2.90±0.42,3.23±0.31,3.41±0.34,2.82±0.36,3.14±0.39;8h,16 h,24h,32 h,40h,48 h VAS scores after activity were:5.92±0.34,5.99±0.38,6.14±0.36,6.42±0.32,5.61±0.32,5.52±0.35.Compared to A group in 8h,16 h,24h,32 h in resting state and after activity VAS score and B group,were lower than B group,and the difference is obvious,with statistical significance(P <0.05),40 h after surgery,the VAS score of the resting and activity state of A B two group were compared after the event.There was not obvious difference and statistically significant(P >0.05).3 Preoperative and 2 weeks after surgery: KSS score of patients in group A clinical KSS score,function score were: 42.61±14.32,40.16±10.78,B group of patients with preoperative KSS clinical score,function score were: 45.12±10.45,36.31±15.35,P >0.05 showed no significant difference.2 weeks after surgery in patients of group A,KSS clinical score and function score were: 85.15±3.15,55.25±5.46,2 weeks after surgery in patients of group B,KSS clinical score and function score were: 79.45±9.98,42.89±11.08,the result shows that P <0.05,the study group was better than the control group.4 There was no significant difference of the two groups of patients in the treatment in the side effects of nausea,vomiting,pruritus and respiratory depression,P >0.05,no significant difference between the two groups.5 The volume of drain output 24 h after surgery: the study group and the control group were: 154.52±29.63 ml and 152.46±29.26 ml,the results of the analysis of the two groups were: P >0.05,no statistical significance.6 The rate of the use of tramadol: after 4h,8h,16 h,24h,48 h.There was no significant difference P >0.05.Conclusions:1 The knee joint function and pain of all the patients were analyzed and compared before and after the surgery.Both study group and control group were significantly improved in two aspects,but the analgesic effect was better in the study group.2 In light of analgesic effect,the study group is better than control group because it can effectively reduce the postoperative pain around the knee,which is beneficial to patients with early functional rehabilitation of knee joint.What's more,patients could return home and to normal life as early as possible,therefore,patients' satisfaction to total knee arthroplasty would increase. |
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