The Clinical Study Of The Local Infiltration Analgesia Among Postoperative Multimodal Analgesia After Total Knee Arthroplasty

The primary goal of total knee arthroplasty(TKA) is to relieve main, improve mobility and correct deformity, it is the effective way to treat severe knee diseases,correct the deformity of knee joint, relieve the pain and reconstruct the function of the knee joint. However, the perioperative pain management of TKA will usually cause middle to severe pain which will lead to series of postoperative complications and seriously affect the functional rehabilitation and early therapeutic effect. Therefore, it is very significant to find a more effective and safety method for postoperative analgesia.The definition of pain given by the WHO and IASP is the unpleasant feeling and emotional experience caused by tissue injury. Pain is not only the response to trauma and disease, but also the most common symptom of diseases. James Campbell, the president of APS, proposed pain as the fifth vital signs in 1995. There are four aspects of pain cause in clinic:1. the pathological impulse of peripheral nerve injury; 2. the algogenic substance released by the cells caused by tissue damage, ischemia,inflammation; 3. stimulation of chemistry and physics; 4. mechanical stimulation to the peripheral nerve. The postoperative pain belongs to the second one. The bad feeling caused by pain prompt people to treat. In medicine, the position of the pain often means the location of the lesions and the character of pain indirectly illustrates the types of pathological process. On the other hand, if it do not affect the illness state, the physician should take the responsibility for the patients’ pain. Since the mechanism and manifestation are different, the pain releasing methods are diversity.In the early 1990’s,the concepts of multimodal analgesia have been put forward. Recently, multimodal analgesia has obtained further development and widely been used in clinic. It isconfirmed that the combined utilization of multiple approach and multiple drugs will not only decrease the dosage of single drug, but also reduce drug-related side effects,and reach the better analgesia effect.Objective: Analyses the curative effect of local infiltration analgesia in multimodal analgesia after total knee replacementMethods:There are 25 patients who primarily accept total knee replacement, and total40 knees, which are divided into two groups: the local infiltration analgesia group and control group. All of the patients take celecoxib(200mg,twice/day), the local infiltration analgesia group(n=20), the patient injects long effective local anesthetic into the rear of distal demur, the rear of proximal tibia, the rear of femoral and tibial medial malleolus, and subcutaneous tissues before close the skin: ropakaklein(100mg X2);opioid drugs: morphine(10mg), 0.4ml adrenaline(1:1000), mix these drugs with normal saline to 100 ml, control group directly close incision.Two groups all accept ketorolac(30mg, twice/day) and celecoxib(200mg, twice/day) after operations, using ketorolac will end after postoperative three days, and taking oxycodone and acetaminophen(330 mg, triple/day) instead. If scores about pain of patients >7 points,inject meperidine hydrochloride 100 mg into muscles. Observe the rest pain of patients at postoperative 6、12、24、48、72h, and take visual analogue scale; VAS scores will be adopted at some fixed activities at postoperative 4d、5d、6d、7d、8d、9d、10d and the time when patients leave hospital, and note use of opioid drugs and the incidence rate about complications related to analgesia.Results: Analyses the 40 knees with statistics,(1)visual analogue scale(VAS): there is no statistic significance by comparing pain scores of knees of two groups before operations, VAS of the local infiltration analgesia group is lower than control group,VAS of the fixed activities which knees reach at postoperative 4d、5d、6d、7d、8d、9d is lower than control groups,VAS of the fixed activities which knees reach at postoperative 10 d and the time when patients leave hospital in two groups is no statistic significance.(2)Complications: complications,such as late healing、infection of incision and tissues necrosis which are caused by injecting around joint, are not found in thetwo group.Conclusion: The research demonstrate that the local joint infiltration analgesia in multimodal analgesia after TKA could prominently decrease the level of pains within72 h and pains of early functional exercise,therefore,it could improve the early joints activities after operations,and there are no prominent side effects and complications.