Efficacy Of Multimodal Analgesia In Postoperation Of Total Knee Arthroplasty

Objective:To compare the effects of multimode analgesia on postoperative analgesia in patients with total knee arthroplasty by comparing four different analgesic regimens.Method:A total of 80 patients with unilateral artificial total knee arthroplasty were enrolled at the First People's Hospital of Chenzhou City in December 2014.They were aged from 50 to 75 years,including 33 males and 47 females.For the A,B,C,D four groups,each group of 20 cases.There were no analgesic drugs in group A before operation.Patients in group B oral celecoxib(200mg / time,QD)for 3 days before operation.No analgesic measures were taken during operation.There were no analgesic drugs in group C before operation but injecting the "cocktail"(ropivacaine needle 200 mg + morphine hydrochloride 10 mg + compound betamethasone 1ml + saline diluted to 80ml)to the knee joint cavity before suture;Patients in group D orally Celecoxib(200mg / time,QD)three days before operation,and injected the "cocktail" to the knee joint cavity before suture.All patients were treated with morphineintravenous analgesia pump,continuous pumping 2ml / h,patients can control the pump to add drug(2ml / time,interval of not less than 15 minutes),and remove the analgesic pump 48 hour after operation.Observe indicators:The visual analogue scale(VAS)was performed at 3 days before operation,4h,6h,12 h,24h,48 h and 72 h after operation,and the movement VAS score at 3 days before operation,12 h,24h,48 h and 72 h after operation;The number of presses of morphine analgesic pump by each group of patients;The occurrence of malignant,vomiting,headache,dizziness,abdominal pain,abdominal distension,urinary retention,deep vein thrombosis cases on each groups;The flexion and extension of knee joint initiative degree and the time required for knee flexion at 90°at 24 h,48h,72 h,1 week and 2 weeks after operation.Result:Postoperative pain score:In group B,C and D the quiescent condition VAS scores at 4h,6h,12 h,24h,48 h and 72 h after operation and the movement scores at 12 h,24h,48 h,72h after operation were significantly lower than those of group A(P <0.05).Between the group B and C there is no significant difference(P> 0.05),Compared with group B and C the score of group D was lower at each time point,and the difference was significant(P <0.05);Postoperative knee flexion and extension range of motion:The range of group A were significantly lower than those of group B,C and D at 12 h,24 h,48 h,72 h and 1 week after operation(P <0.05),there was no significant difference in the range ofmovement after 2 weeks of operation(P> 0.05).There was no significant difference between the two groups at each time point.The range of movement of group D was significantly higher than that of group B and C at 12 h,24h,48 h and 1 week after operation.The time required for knee flexion at 90°:group D was the shortest,groups B and C followed,group A was the longest.Conclusion:Compared with no other analgesic method,intra-articular injection of drug analgesia,the effect of multi-mode analgesia is better,indicating that multi-mode analgesia can improve the perioperative analgesic effect of total knee arthroplasty;Multi-mode analgesia is conducive to the early recovery of patients,so that patients return to society as soon as possible which improve the patients' satisfaction with the operation;Each analgesic method in the multi-mode analgesia is easy to operate,and this multi-mode analgesia is safer and have lower adverse reactions.