Efficacy Of Sufentanil-containing Cocktail Therapy In Postoperative Analgesia After Total Knee Arthroplasty

Objective To investigate whether the addition of sufentanil to "cocktail therapy" enhances its analgesic effect after Total Knee Arthroplasty(TKA).Methods A double-blind randomized controlled study was conducted to collect 120 patients with knee osteoarthritis with unilateral total knee replacement admitted to The 940 th Hospital of Joint Logistics Support Force of The Chinese People’s Liberation Army joint surgery from November 1,2021,to November 30,2022.The envelope method was used to randomly divide the 120 patients into two groups of 60 patients each,and all patients underwent intralesional anesthesia.Patients in the experimental group were given basic cocktail therapy with the addition of sufentanil(ropivacaine hydrochloride 150 mg +epinephrine hydrochloride 0.2 ml + compound betamethasone 1 ml + ketorolac amino triol injection 30 mg + sufentanil citrate 50ug);all patients in the control group were given basic cocktail therapy(ropivacaine hydrochloride 150 mg + epinephrine hydrochloride 0.2 ml +compound betamethasone All patients in the control group were given basic cocktail therapy(ropivacaine hydrochloride 150 mg + epinephrine hydrochloride 0.2 ml + compound betamethasone 1 ml + ketorolac amino triol injection 30 mg).Visual Analogue Scale(VAS)scores of pain at rest before and 8,16,24,36,48,and 72 h after surgery;VAS scores at the activity before and 16,24,36,48,and 72 h after surgery;time to first attain straight leg elevation after surgery;active maximum knee flexion before and 24,48 and 72 h after surgery;active maximum knee flexion before and 24,48 and 72 h after surgery.The number of hemoglobin(HGB)and white blood cell(WBC)counts before and 24 and 72 h after surgery;the number of people using parecoxib injection and additional opioid analgesia in each 24 h during the first 3 days after surgery and the incidence of postoperative adverse effects were statistically analyzed;the effectiveness and safety of adding sufentanil to the drug formulation of cocktail therapy were investigated.Results There was no statistically significant difference(P > 0.05)between the patients in the experimental group and the study group in comparing all the preoperative data,and the postoperative data of the two groups were comparable.The VAS was smaller in the experimental group compared with the control group at 8,16,and 24 h postoperative resting state,and the difference was statistically significant(P < 0.05);the difference in VAS scores at 36,48,and 72 h postoperative resting state was not statistically significant(P > 0.05).In the experimental group,compared with the control group,the VAS scores in the active state at16,24,and 36 h after surgery were smaller,and the difference was statistically significant(P< 0.05);the difference in VAS scores in the active state at 48 and 72 h after surgery was not statistically significant(P > 0.05).The time to complete the first straight leg raise was shorter in the experimental group compared with the control group,and the difference was statistically significant(P < 0.05).The active maximum knee flexion was greater in the experimental group compared with the control group at 24 h postoperatively,and the difference was statistically significant(P < 0.05),while the difference in active maximum knee flexion at 48 and 72 h postoperatively was not statistically significant(P > 0.05).There was no statistically significant difference in the number of red blood cells and white blood cells in the experimental group compared to the control group at 24 and 72 h postoperatively(P > 0.05).The difference in the number of parecoxib use in each 24 h in the first three days after surgery was not statistically significant in the experimental group compared with the control group(P>0.05);the number of opioid analgesic use in the first two 24 h in the first three days after surgery was less in the experimental group compared with the control group,and the difference was not statistically significant in the third 24h(P<0.05).The differences in the rates of postoperative nausea and vomiting,skin pruritus,urinary retention,and total adverse reactions were not statistically significant in the experimental group compared with the control group(P > 0.05).Conclusion Sufentanil-containing cocktail therapy is more advantageous than basic cocktail therapy in reducing patients’ early post-TKA pain,improving early joint mobility,and completing early straight leg raises.Therefore,we recommend the addition of sufentanil to cocktail formulations in the absence of relevant contraindications.