Multimodal Analgesia On The Influence Of Early Functional Rehabilitation After Total Knee Arthroplasty

Objective:To explore the analgesic effect of different analgesia methods in total knee arthroplasty, and to observe the early postoperative functional exercise and rehabilitation.Methods:In this study, the TCM Hospital of Sichuan Province/The Affiliated Hospital of Chengdu University of TCM, Sichuan Province Hospital Department of orthopedics in accordance with the inclusion and exclusion criteria, to randomly divided 60 patients underwent unilateral TKA surgery into two groups:the observation group of 30 cases using multimodal analgesia:preoperative analgesia (Celecoxib Capsules) and psychological counseling, the joint operation in the surrounding tissue injection analgesic (Ropivacaine Hydrochloride Injection+ Adrenaline Hydrochloride Injection), continuous femoral nerve block analgesia postoperative (Ropivacaine Hydrochloride Injection); 30 cases in the control group, using the traditional single analgesic methods:preoperative psychological counseling, postoperative patient-controlled intravenous analgesia (sufentanil+Tropisetron Hydrochloride Injection). In 3 days after the operation according to the condition whether need to give additional analgesia, and at different time points were recorded in the resting state and active visual analogue score, knee range of motion, motor block, unit four biceps muscle strength, analgesic dosage and adverse reaction.Results:The observation group immediately after surgery and postoperative 8h,24h, 48h in the resting VAS score and postoperative 24h,48h activities under the score of VAS was significantly lower than the control group (P<0.05). The patients of two groups in the preoperative, postoperative 3d,7d, lOd and 14d, there was no significant difference in the VAS score of the resting state and active state (P>0.05). The patients in the observation group 1d,2d,3d and 7d, the knee joint ROM greater than the control group (P<0.05). The patients of two groups in the preoperative, postoperative 10d and 14d, there was no significant difference of the knee joint ROM (P>0.05). In the postoperative 8h,16h,24h and 2d, the observation group of unit four biceps muscle strength were better than the control group, the difference was statistically significant (P<0.05). After the postoperative 3d, the two groups had no statistical significance (P>0.05) of unit four biceps muscle strength. The observation group in the postoperative analgesic consumption demand significantly decreased than the control group (P<0.05). There was no statistical difference in movement blockade and adverse reaction between two groups(P>0.05).Conclusion:Compared with patient controlled intravenous analgesia, Multimodal analgesia in the TKA can effectively relieve postoperative pain, improve joint mobility, reduce opioid class the dosage of analgesic drugs, and no obvious motor block, so as to promote early functional exercise of patients, and is beneficial to patients'rehabilitation.