Comparative Study Of Multimodal Analgesia And Traditional Analgesia In Total Knee Arthroplasty

Objective:To compare the effects of multimodal analgesia and traditional analgesia in total knee arthroplasty (TKA), and the implications for the early knee rehabilitation of patients.Methods:58 cases were included who were of proposed for initial unilateral total knee arthroplasty (TKA) in Sichuan Provincial People’s Hospital from march 2014 to December 2014. We recorded age, gender, body mass index (BMI), resting and activity preoperative visual analog pain scale (VAS score), preoperative ipsilateral American Keen Society Score (KSS score). Patients were randomly divided into experimental group (multimodal analgesia group) with 29 cases and control group (conventional analgesia group) with 29 cases. Patients in the experimental group took celecoxib 200mg at the 8pm the day before surgery and 6am in the morning of surgery day, and ipsilateral continuous femoral nerve block was carried out by anesthesiologists in the operating room. Moreover, the’cocktail’was injected including 100ml into the incision muscle, fascia and subcutaneous soft tissue before closing the wound and 50ml into the joint cavity after closing the wound with drainage tube pinching 2 hours which was extubated first day postoperative. While the control group using a continuous femoral nerve block,50ml saline was injected into the joint cavity by drainage tube after closing the wound, pinching 2 hours, extubated at first day postoperative. Both groups were given postoperative incision around the ice 72h, femoral nerve block catheter 72h, parecoxib 40mg im q12h x3d, celecoxib 200mg bid early in the morning of the first day postoperative, paracetamol and tramadol lco tid x 14d. If the patient was still pain analgesic after using the above scheme, as the case may be added with tramadol 100mg im. Two groups of patients’ surgery were performed by the same group of surgeons. Patients were recorded by KSS score preoperative, took rivaroxaban 10mg qd 35d anticoagulation postoperative. VAS scores were recorded 24h postoperative after two groups of patients under resting and activity,48h after resting state and activity scores,72h after the resting state and activity scores. Time was recorded when Limb active flexion up to 60 ° and 90 °, first ambulation after surgery. We also recorded the postoperative drainage within 24’. and KSS score after two weeks. Follow-up data was analyzed by statistical software SPSS 22.0. Results:1. two groups of patients in terms of gender age, body mass index (BMI) and other general information with no statistical significance (P> 0.05); the resting state and activity VAS score, KSS score preoperative on the distribution of the difference was not significant (P> 0.05),which was comparable; 2. No significant difference (P> 0.05) in plasma drainage within 24 hours in the two groups; 3. Resting state and activity VAS scores were significantly different (P<0.05) after 24h,48h,72h postoperative; 4. Differences (P<0.05) were identified on KSS clinical score distribution after two weeks. There was a significant difference (P<0.05) after two weeks on the function score distribution of KSS:5. active knee flexion reached 60 ° and 90 °required time, the maximum angle at the knee after two weeks of active flexion, postoperative first time ambulation, all difference was statistically significant (P< 0.05).Conclusions:1. All the 54 patients in experimental group and the control group obtained better knee function and less pain postoperative compared with preoperative, which is relatively better efficacy of the experimental group, indicating that multimodal analgesia scheme can enhance the efficacy of TKA.2. Multimodal analgesia compared to conventional analgesia, allowing patients effectively relieve pain after TKA, with patients promoting functional rehabilitation earlier, more conducive to the patient to return to society as soon as possible, improving surgical satisfaction.3. Multimodal analgesia scheme is simple, without increasing the operative time. All the patients in the experimental group applied multimodal analgesia scheme got no adverse reactions and local complications, indicating that its safe, clinically worthwhile promotion.4. Two groups of patients were not used opioids in hospitalization, avoiding the use of opioids due to adverse reactions such as lethargy, retention of urine, respiratory depression, addiction, and helping to improve the satisfaction of patients and clinical safety.