The Effect Of Etoricoxib Preemptive Analgesia Combined With Dexamethasone On Early Rehabilitation After Total Knee Arthroplasty

Objective:To investigate the effect of etoricoxib preemptive analgesia combined with dexamethasone on early rehabilitation after total knee arthroplasty,and to detect the levels of inflammatory factors.It provides an effctive treatment option to relieve early postoperative pain and improve early postoperative function of total knee arthroplasty.Methods:A total of 90 patients who met the criteria for unilateral total knee arthroplasty were selected and randomly divided into group A,group B and group C.Group A did not take any preemptive analgesics before operation,Group B received 120mg of etoricoxib orally in the morning of surgery,group C received 120mg of etoricoxib orally in the morning of surgery,and intravenous injection of 10mg dexamethasone before anesthesia.All operations were performed by the same team of surgeons.The same analgesic regimen was used after the operation.Main observation indexes:visual pain score(VAS)(from POD1 to POD5 and 1 month after operation),the ranges of motion of the knee(ROM)(POD1,POD3,POD5 and 1 month after operation),Hospital for Special Surgery knee score(HSS)(POD3,PODS and 1 month after operation),the length of hospital stay and complications such as postoperative nausea and vomiting.Serum levels of inflammatory factors were detected on POD1,POD3,POD5.Results:1.The VAS scores were compared among the three groups.The VAS scores in group C were lower than those of group A and group B from POD1 to POD4(P<0.05).The VAS scores in group B were lower than group A on POD 1 and POD2(P<0.05),but there was no significant difference among the three groups on POD1 and 1 month after operation.2.The range of ROM in group C were better than those of group A and group B on POD1,POD3 and PODS(P<0.05).The range of ROM of group B were better than those of group A on POD1 and POD3(P<0.05).There was no significant difference in among the 3 groups on 1 month after operation(P>0.05).3.The scores of HSS in group C were better than those of group A and group B on POD3 and POD5(P<0.05).The scores of HSS in group B were better than those of group A on POD3(P<0.05).There was no significant difference among the 3groups on 1 month after operation(P>0.05).4.The LOS in group C was significantly shorter than that of group A and group B(P<0.05),but there was no significant difference between group A and group B(P>0.05).5.In terms of inflammatory factor detection,the level of CRP in group C was lower than that of group A and group B on POD1,POD3 and PODS(P<0.05),and the level of CRP in group B was also lower than that of group A on POD1,POD3 and POD5(P<0.05).The levels of IL-6 and TNF-? in group C were lower than that of group A and group B on POD1 and POD3(P<0.05),the levels of IL-6 and TNF-? in group B were also lower than that of group A on POD1 and POD3(P<0.05),but there was no significant among 3 groups.Conclusion:Etoricoxib preemptive analgesia combined with dexamethasone can reduce the early postoperative pain,reduce the level of inflammatory factors,and promote the early rehabilitation of knee function.However,neither etoricoxib preemptive analgesia or assisted etoricoxib preemptive analgesia combined with dexamethasone had no effect on the postoperative pain on 1 month after operation.