Evaluation Of Multimodal Preemptive Analgesia In Orthopaedic Sugery

Objective: To evaluate the multimodal preemptive analgesia effect in the orthopaedic post-operative patients.Methods: Ninety patients (53 male,37 female, age from 18 to 80, average 46.7 years old) scheduled for orthopaedic surgery were randomly divided into three groups: Group A received 400mg of celecoxib on both 24hr and 2hrs before the surgery and 400mg of celecoxib from POD0 to POD5 and 200mg until POD14 plus PCIA (fentanyl 1.0mg/100ml) postoperatively; Group B received 400mg of celecoxib only on 2hrs before the surgery and 400mg of celecoxib from POD0 to POD5 and 200mg until POD14 plus PCIA postoperatively; Group C received 400mg of celecoxib from POD0 to POD5 and 200mg until POD14 plus PCIA postoperatively. Before celecoxib administration and after the operation, pain intensity was measured using visual analogue scale (VAS), and analgesic requirements, side effects, sleep disturbance, vital signs including HR,RR,BP,SpO₂, blood loss and change of hematology index were compared. Satisfied score and VRS pain score at 1 month were also measured.Result: Compared with group C, the patients with multimodal preemitive analgesia groups had significantly lower VAS pain scores after the operation (P < 0. 05) and lower sleep disturbance (P < 0. 05), but there were no marked differences in the VAS pain sores between multimodal preemitive analgesia groups of different timing administration before operation (P > 0.05). It was also found that the multimodal preemitive analgesia groups was more satisfied with analgesia treatment and experienced less pain after 1 month discharge (P < 0.05) Thus the total consumption of analgesic requirements and opioid-related adverse effects morbidity between three groups had no significantly differences (P > 0.05). Moreover, three groups had no differences in the vital sign, change of hematology index and blood loss (P>0.05)..Conclusion: The multimodal preemitive analgesia with COX-2 inhibitor in coordination with PCA in patients undergoing orthopaedic surgery can reduce post-operative pain and sleep distburbance, demonstrated more satisfaction in patients and better chronic pain rate after diacharge, without affecting the platelet and coagulation function. Thus the best timing of administration before operation still need further resresearch.