Multi-mode Preemptive Analgesia In The Clinical Application Of Bone And Joint Surgery

Objective:To evaluate the multimodal postoperative analgesia effects of celecoxibcombined with PCA and its clinical efficacy and related adverse events in orthopaedicprocedures．Methods：Ninety patients(53male，37female，age from18to80，average46.7yearsold) scheduled for the orthopaedic surgery were randomly divided into three groups：Group A received400mg of celecoxib before the surgery and400mg of celecoxibsfrom POD0to POD5and200mg until PODl4plus PCIA(1．0mg／100m1)postoperatively；Group B received400mg of celecoxib before the surgery and400mg ofcelecoxib from POD0to POD5and200mg until POD14plus PCIA postoperatively；Group C received400mg of celecoxib from POD0to POD5and200mg until POD14plus PCIA postoperatively．Visual analogue scale(VAS) scores，PCA presstimes，cumulative volumes of fentany were assessd every4hrs postoperatively until48hrs．Sleep disturbance，vital signs including HR,RR,BP,Sp02and side-effects includingoversedation，nausea，emesis，pruritus and dyspna were observed for2days．Blood-Rtest and coagulation function test were examed preoperatively or postoperatively onPOD1，3．Bloodloss，satisfied score and chronic pain situation at1month were alsomeasured．Results: Compared with group C， the patients with multimodal preemitiveanalgesia groups had significantly lower VAS pain score safter theoperation(P<0.05)and lower sleep disturbance(p<0.05)，but there were no markeddifferences in the VAS pain sores between multimodal preemitive analgesia groups ofdifferent timing administration before operation(P>0.05)．It was also found that themultimodal preemitive analgesia groups was more satisfied with analgesia treatmentand experienced less pain after1month discharge(P<0.05).Thus the total consumption of analgesic requirements and opioid-related adverse effects morbidity between threegroups had no significantly differences(P>0.05)． Moreover,three groups had nodifferences in the vital sign，change of hematology index and bloodloss (P>0.05).Conclusions: The multimodal preemitive analgesia with COX-2inhibitor incoordination with PCA in patients undergoing orthopaedic surgery can reducepost-operative pain and sleep distburbance，demonstrated more satisfaction in patientsand better chronic pain rate after diacharge， without affecting the platelet andcoagulation function．Thus the best timing of administration before operation still needfurther resresearch．...