Effect Of Improving Postoperative Sleep Quality With Doxepin Drugs On Early Recovery Of Patients Following Total Knee Arthroplasty

OBJECTIVE:In this study,patients diagnosed with osteoarthritis of the knee and undergoing total knee arthroplasty were given postoperative doxepin to improve the quality of postoperative sleep.This study plans to investigate the effect of improving the quality of postoperative sleep on the functional recovery of patients after total knee arthroplasty.METHODS:Seventy-one patients,nineteen men and fifty-two women,who underwent unilateral total knee arthroplasty(TKA)for the first time were included in this study.All patients were divided into experimental group or control group according to whether they were taking doxepin after surgery.Seventy-one patients were followed up successfully,including thirty-five patients in the experimental group,ten men and twentyfive women,aged 67.74±5.97 years,and thirty-six patients in the control group,nine men and twenty-seven women,aged 66.64±6.46 years.All patients in the experimental group were given doxepin drugs intervention after surgery,and the static and dynamic VAS(Visual Analogue Scale)scores at 24 h and 72 h after surgery,the 90° time of knee flexion on the affected side after surgery,and the Pittsburgh sleep quality index(PSQI)scores and Insomnia Severity Index(ISI)scales at 1,2 and 4 weeks after surgery,Hospital for Special Surgery(HSS)scores at 2,4,and 8 weeks postoperatively,and postoperative complications were recorded in the two groups.Multiple linear regression models were applied to analyze the factors affecting early postoperative rehabilitation of the knee joint.RESULTS:The differences between the two groups in terms of preoperative statistical analysis such as age,gender,BMI,operation time,HSS scores,diabetes and ASA classification were not statistically significant and comparable(P>0.05).The PSQI scores and ISI scores were lower in the experimental group than in the control group at 1,2 and 4 weeks postoperatively(P<0.05),which shows that patients in the experimental group had better postoperative sleep quality than the control group.The HSS scores at 2,4,and 8 weeks postoperatively were higher than those of control patients(P<0.05),the VAS scores at 72 h postoperatively in the exercise and resting states were lower than those of the control group(P<0.05),and the time required for postoperative knee flexion at 90° was shorter than that of the control group(P<0.05),indicating that patients in the experimental group had better early postoperative recovery and lower postoperative pain levels.The patients in the experimental group had lower VAS scores under exercise and resting state at 24 h after surgery than the control group,and there was no statistically significant difference in VAS scores between the two groups at 24 h after surgery(P > 0.05).Postoperative PSQI scores and ISI scores affected postoperative HSS scores,indicating that postoperative sleep quality is significantly correlated with the early postoperative recovery.Patients in the experimental group occasionally experienced daytime drowsiness,dry mouth,and gastrointestinal discomfort after surgery,and no other related adverse effects or postoperative complications were observed.CONCLUSION:Doxepin can improve patients’ sleep quality and has few side effects.It has a certain analgesic effect.Improving postoperative the quality of sleep can improve patients’ postoperative pain tolerance,reduce postoperative pain,reduce patients’ stress sensitivity and reaction to postoperative rehabilitation,which can promote joint function recovery,and accelerate the rehabilitation process.