Clinical Study On COX-2 Inhibitor Sequential Therapy Combied PCA Controlling TKA Postoperative Pain

Objective: To observe COX-2 inhibitor sequential therapy in combination with PCA controlling effect of pain, explore new methods of TKA postoperative pain control. To analysis change of improved knee injury score (improved HSS) in the near future-within half a month after pain are effectively beyond control, validate strict analgesia after TKA can significantly improve the functional rehabilitation of the knee joint.Methods: On the consent of the Medical Ethics Committee, from March 2009 to June 2010, 60 patients with single knee joint surface replacement were performed under the same set of operations physicians, anesthesiologists and nursing staffing, including 15 cases of severe traumatic arthritis knee joint, IV-Ⅴ45 cases of osteoarthrosis, among which are male 29, female 31 cases, age 58--75, on average age of 67 years old, with ASA grade I or II, selecting inhalational-intravenous anesthesia. Generally reset balloon tourniquet, selecting the knee medial Para median vertical incision, length 14-18 cm, rotating platform of the posterior cruciate ligament prosthesis, wash the wound with pulse for 5 minutes before suturing incisions, a routine three-layer off, subcutaneous suture, close the incisions. Randomly divided into a control group and the contrasts, following the same routine formula (fentanyl 1.0MG added 0.9%NS to 100ML) making PCA solution, set up a standard approach to medicine, running 48 hours before extraction. When closing the incision experimental group inject parecoxib sodium 40mg + NS 2ml intravenously, control group inject NS 2ml intravenously, and same reagents used in an interval of 12 hours of continuous intravenous infusion until 60 hours later. From the 72nd hour, experimental group use celecoxib orally for 2 consecutive weeks, control group given comfort capsules. At following points in time, before and after operation 2, 4, 6, 9, 12, 24, 48, 72, 96, 108 hours, estimate VAS score of patients under active activity and resting state; measure scores of improved knee injuries on the days of preoperative and postoperative 3rd day, 7th day, 15th day; record the effective number of PCA-controlled.Results: There was no statistically significant in general condition and no statistical difference in preoperative evaluation of knee joint between two groups. There were significant differences (p﹤0.01 or 0.05) in improvement scores of knee joint between experimental group and control group, on the 3rd, 7th, 15th days after the operation. Fentanyl dosage of the experimental group compared with control group decreased by 33.4%。Conclusion: The effect that COX-2 inhibitors combined PCA control TKA postoperative pain is exact, which can significantly improve the TKA early postoperative functional rehabilitation, at the same time significantly reduce central analgesics dosage, reduce central analgesics inherent side effects.