Comparison Of Analgesic Effects Of Patient-controlled Epidural Analgesia And Patient-controlled Intravenous Analgesia After Total Knee Arthroplasty

Background The incidence of knee osteoarthritis (OA) on 60-70 years old patients is 60% to 70%. Total knee arthroplasty (TKA) is one of the clinical techniques for treating terminal stage knee osteoarthritis. However, without preventing or managing postoperative pain effectively, severe pain occurs on about 60% patients who underwent TKA.Postoperative pain can induce cardiovascular complications, such as arrhythmia, hypertension and myocardial ischemia,and increase the incidence of venous thrombosis and pulmonary infection. An effective prevention of postoperative pain will reduce or even avoid such complications and thus benefit the patients on postoperative recovery.Spinal anesthesia and intravenous analgesia are the two major clinical analgesia techniques. Spinal anesthesia includes epidural analgesia, subarachnoid block and combined spinal- epidural analgesia (CSEA). Among them, epidural analgesia has been proven always having the best analgesia outcome. Patient-controlled analgesia (PCA) technique has emerged as a popular drug deliver method for analgesia. Currently, patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) have become the two major postoperative analgesia strategies. The analgesia effects of PCEA and PCI A after orthopedic surgeries on lower limb have been proven. However, the analgesia outcomes of these two techniques after specific orthopedic surgeries, such as TKR, have not been analyzed and compared. What’s more, the potential complications of PCEA and PCIA, such as nausea,vomiting, drowsiness, dizziness, urinary retention, gastrointestinal motility dysfunction,respiratory depression, hypopiesia, subdural hematoma and infection, have not been reported systematically and there is no standard clinical guidance for preventing or treating these complications.Objectives The objectives of this study are to (1) compare the complications and postoperative analgesia outcomes of PCEA and PCIA after total knee replacement (TKR).(2)summarize the advantages and disadvantages of using PCEA after TKR; (3) make relevant postoperative analgesia and nursing strategies on patients underwent joint surgeries; and (4)give recommendations on painless ward establishing and management for relevant clinical departments.Methods From September 2014 to November 2015, 120 OA patients who matched specific inclusion criteria were included prospectively and randomly divided into group PCEA and group PCIA in average in the orthopedic department of the Second Hospital of Jilin University. All patients received CSEA during unilateral TKA surgeries and then either PCEA or PCIA. Visual analogue scale (VAS) pain scores were recorded at each time point of 6、12、24、36 and 48hr postoperatively. Summarize patient satisfactions about postoperative analgesia after 2 days. Summarize and evaluate the complications and analgesia outcomes of PCEA, PCIA after TKR. The enumeration data were compared with the x2 test and measurement data were compared with rank-sum test using SPSS 19.0 software. Significance was indicated by P< 0.05.Results At 6h, 12h, 24h, 36h,48h time points after TKA, VAS scores in group PCEA were lower than those in group PCIA (P < 0.001). At 48h after TKA, patient overall satisfaction in group PCEA was higher than group PCIA (P < 0.05). The incidences of complications such as nausea, vomiting incidence, somnolence in group PCEA were lower than those in group PCIA (P < 0.05).Conclusion Compared with PCIA, PCEA has better postoperative analgesia outcome,lower incidence of adverse reactions, less demand of analgesic, and higher patient satisfaction.