| Objective: Arthroscopicknee surgeryis a relatively non-invasive surgery,consuming shorter time and allowing the patient to return to daily activities sooner,and it become the most common diagnosis and treatment surgery for sports injury.But postoperative pain is a serious problem to patients,and previous evidence shows that 57%-76% of postoperative patients need endure moderate or severe pain.So effective pain management is important to ensure that the patients is comfortable and can mobilize sooner after arthroscopic knee surgery.The opioids combing with other drugs could be a good choice for this pain,and the morphine is preferred opioids for a strong analgesic effect.The studies of morphine show that intraarticular administration of morphine have better effects and lesser adverse reactions.At present,intraarticular morphine combing with ropivacaine is a main method of pain relief after arthroscopic for which ropivacaine is a drug of good analgesic effects and few adverse reactions,and it can act as a supplement for morphine in analgesic time.But recently studies show that ropivacaine and other local anesthetic can inhibit the activity of chondrocytes,disrupt the metabolism of cartilage cells and have a toxicity to inter-cartilage mesenchymal progenitor cells,which may produce irreversible damage to chondrocytes and promote the progress of osteoarthritis.Parecoxib is selective inhibition of cyclooxygenase-2 non-steroidal antiinflammatory drugs,and it used to moderate and severe pain and have few adverse reactions.This study not only investigates the analgesic effects of intramuscular parecoxib combing with intraarticular morphine for knee arthroscopy,but compared the analgesic effects of preemptive and postoperative using parecoxib,searching for a better alternative drugs for ropivacaine and analgesic scheme and supporting some advice to postoperative fast track of arthroscopicknee surgery.Methods:Eighty patients,American Society of Anesthesiologists physical status I-II,aged 18-65 years,was included in this prospective study.Diseases include meniscal tear,articular cartilage injury,plica syndrome,intraarticular loose bodies and osteoarthritis of the knee,and a patient could have one or more disease.Surgery methods include the intraarticular debridement,meniscal trimmed,chondroplasty,loose body and plica removal by knee arthroscopic.All patients were randomly divided into four parts and each part have 20 patients.Four groups of patient's handling include: intramuscular administration of 40 mg parecoxib in 30 minutes before operation combining with intraarticular administration of 5mg morphine after operation in group A,intramuscular administration of 40 mg parecoxib combining with intraarticular administration of 5mg morphine after operation in group B,intraarticular administration of 100 mg ropivacaine in 30 minutes before operation combining with intraarticular administration of 5mg morphineafter operation in group C,intraarticular administration of 100 mg ropivacaine combining with 5mg morphine after operation in group D.The supplemental analgesia postoperatively was tramadol tablets.Before operation,the each group patient's age,gender,body mass index(BMI),the visual analogue scale(VAS)scores of patients at rest and on knee motion of 60 degrees,the range of knee joint motion,the HSS scores of injury limb,the serum IL-6,TNF-?'s value were recorded.During operation,the time of operation and tourniquet's using were recorded.After operation,the VAS scores at rest of2 h,4h,6h,12 h,24h,72 h and on knee motion of 60 degrees of 4h,6h,12 h,24h,72 h,the time of the frist oral tramadol tablets positively and the quantity of the analgesics within 3 days postoperatively,the time of injured limb raising to 30 degrees with straight leg and knee bent to 60 degrees,the range of knee joint motion and the HSS scores of injury limb in 24 h and 72 h after operation,the rate of vomiting,itching,respiratory depression and other adverse reactions within 3 days postoperatively,the IL-6,TNF-?'s value of the serum at 1 day and 3 days postoperatively and intraarticular effusion were recorded.Results:All participants have completed the experiment,the age,gender,BMI,the VAS scores of patients at rest and on knee motion of 60 degrees,the range of knee joint motion,the HSS scores,the serum IL-6,TNF-?'s value preoperatively of the four groups of patients have not significant difference(P>0.05).The group A's VAS scores of 6h,12 h,24h at rest and 4h,6h,12 h,24h,72 h on knee motion of60 degrees postoperatively were significantly lower than group C(P<0.05),the time of requiring tramadol postoperatively were significantly later than group C(P<0.05),the time of injured limb raising to 30 degrees with straight leg and knee bent to 60 degrees postoperatively were significantly earlier than group C(P<0.05),the IL-6,TNF-?'s value of serum at 1 day and 3 days postoperatively were significantly lower than group C(P<0.05).The group B's VAS scores of 6h,12 h,24h at rest and 4h,6h,12 h,24h on knee motion of 60 degrees postoperatively were significantly lower than group D(P<0.05),the consumption of tramadol within 3 days postoperatively were significantly lower than group D(P<0.05),the time of requiring tramadol postoperatively were signifycantly later than group D(P<0.05),the time of injured limb raising to 30 degrees with straight leg and knee bent to 60 degrees postoperatively were significantly earlier than group D(P<0.05),the IL-6,TNF-?'s value of serum at 1 day and 3 days postoperatively were significantly lower than group D(P<0.05).The group A's VAS scores have not significant difference with group B(P>0.05),the consumption of tramadol within 3 days postoperatively were significantly lower than group B(P<0.05),the time of injured limb raising to 30 degrees with straight leg and knee bent to 60 degrees postoperatively were significantly earlier than group B(P<0.05),the IL-6,TNF-?'s value of serum at 1 day and 3 days postoperatively were significantly lower than group B(P<0.05).The group C's VAS scores of 6h,12 h at rest postoperatively weresignificantly lower than group D(P<0.05),the consumption of tramadol within3 days postoperatively were significantly lower than group D(P<0.05).After operation,the tramadol required rate of group A was 30%,the group B was50%,the group C was 65%,the group D was 60%.Some patients shows vomiting,itching,palpitation within 3 days postoperatively,and vomiting was the most common adverse reactions.The incidence of complication: group A was 40%,group B was 45%,group C was 65% and group D was 70%.Conclusion: Intramuscular parecoxib combining with intraarticular morphine have better result than intraarticular ropivacaine combining with morphine in postoperative analgesic effects of rest and motion,functional recovery,suppression of inflammatory cytokine release and reducing complications.Although the VAS scores of intramuscular parecoxib of preoperative and postoperative have not significant difference,intramuscular parecoxib preoperatively need fewer tramadol and have better effect of suppression of inflammatory cytokine release,so the effect of preemptive analgesia of parecoxib was better.Intraarticular ropivacaine preoperatively have better analgesic effects after 6h at rest and need fewer tramadol than postoperative,so the effect preemptive analgesia of ropivacaine was better.Intramuscular parecoxib combining with intraarticular morphine have better result than intraarticular ropivacaine combining with morphine and this scheme can act as postoperative analgesic scheme of arthroscopicknee surgery,and the effectcould be better as preemptively using parecoxib. |
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