The Study On The Effect Of Selective COX-2 Inhibitors For Perioperative Pain In Enhanced Recovery After Total Hip Arthroplasty

Background:Osteoarthritis(OA)is a kind of frequent joint sickness with chronic and degenerative.The high incidences of osteoarthritis increases with age,especially hip osteoarthritis.Hip osteoarthritis has obvious symptoms such as pain and morning stiffness,and deformity,disability severely,or claudication with the lower limbs,which is the main cause of activity limitation and limb dysfunction in the elderly.Total hip arthroplasty(THA)is the main treatment for end-stage hip osteoarthritis,which can not only eliminate pain,correct the deformity of hip and reconstruct its function,but also reduce the risk of disability and improve the quality of patients’ life.However,the trauma of THA is intensity,and it is often accompanied by persistent moderate to severe pain after surgery.Patients often treat negatively or intentionally avoid early postoperative training due to fear of pain,which delays postoperative rehabilitation and increases the risk of adverse events,affecting the effect of surgery.Therefore,effective control of postoperative pain is the key to promote enhanced recovery after surgery(ERAS)for patients after THA.Preemptive analgesia(PEA)is to block the transmission of noxious stimuli to the central nervous system,inhibit the sensitization of central and peripheral nerve pain impulses,increase the pain threshold of patients,and improve the perception of postoperative pain.Ideal pain control can enable patients to actively enter early postoperative rehabilitation exercise,promote the recovery of joint function,and achieve ERAS.Cyclooxygenase-2 selected inhibitors(COXIBs)has good analgesic effect and low incidence of adverse events,and have been widely used in THA clinic practice.Previous studies have demonstrated the safety and efficacy of COXIBs in preemptive analgesia for THA.However,the application timing of preemptive analgesia is rarely discussed.The effect of preemptive analgesia with COXIBs at different times on postoperative analgesia and the realization of ERAS in the perioperative of THA remains to be explored.Objective:To analyze the clinical efficacy of preemptive analgesia with COXIBs in THA,to explore the advantages and disadvantages of preemptive analgesia with COXIBs in different application timing for postoperative analgesia after THA,to find the most suitable application timing,and to provide reference for the optimization of clinical application scheme of preemptive analgesic with COXIBs in the perioperative THA under the ERAS’ concept.Methods:This study was a prospective,double-blind,randomized,controlled clinical study,which was approved by the Ethics Committee of the China Registry Clinical Trials(No.CHECRCT20210189).Seventy-six patients with hip osteoarthritis who were scheduled to undergo primary unilateral THA in the Department of Orthopaedics of Henan Provincial People’s Hospital from May 2020 to September 2021 were selected to apply preemptive analgesic with COXIBs.The patients were divided randomly into two groups by digital table,A and B,with 38 patients in each group.Group A was given 40 mg COXIBs parecoxib(Dynastat)at 21:00 the night before surgery,Group B was given parecoxib 40 mg 2 hours before surgery.Both groups were given imrecoxib(Hengyang)0.1g Bid,combined with automatic intravenous analgesia pump(PCIA)for routine analgesia after surgery.When the pain was intolerable or the postoperative resting VAS reached 4 point,dezocine was given for remedial analgesia.The resting VAS and active VAS of the two groups were recorded at 6h,12 h,24h,48 h and 72 h after surgery.The number of PCIA effective compressions,the number of requiring remedial analgesia,and the incidence of drug side effects such as nausea and vomiting within 24 h after surgery.Results:There was no statistical difference in the baseline indexes before surgery(P<0.05).Postoperative resting VAS at 72 h showed no significant difference between the two groups(P=0.055,P>0.05),and group A was lower than group B at all other time points(P<0.05).Postoperative active VAS at each time in group A were lower than those in group B(P<0.05).Within 24 h,the number of effective compressions of PCIA in group A was less than that in group B(P<0.05),and the number of cases requiring remedial analgesia in group A was less than that in group B(P<0.05).There was no statistical difference in the incidence of a drug side effects between two groups(P>0.05).Conclusion:The analgesic effect of preemptive analgesia with COXIBs after THA is closely related to the timing of its application.The analgesic effect of preemptive analgesia with COXIBs one night before surgery is more significant than that two hours before surgery.One night before surgery is more beneficial for patients to actively enter early postoperative joint function training,which is more beneficial to promote the realization of ERAS in THA clinical,so as to improve the medical effect of THA,and improve the medical satisfaction of patients.