A prospetive study of two multimodes of analgesia for total knee arthroplasty

TANG Yang; DING Yong

doi:10.3969/j.issn.2095-252X.2016.10.002

Abstract：Objective To compare the clinical effects of 2 different multimodal analgesia in total knee arthroplasty.Methods The clinical data of a total of 86 patients with severe osteoarthritis who underwent total knee arthroplasty were analyzed. All were divided into 2 groups by random numbers: group A and group B, and 2 groups were treated with preoperative preemptive analgesia and injection with mixed analgesics around the knee joint in the operation. Patients in group A received continuous femoral nerve block after the operation, and patients in group B received analgesia by patient-controlled intravenous analgesia pump. Rest and active VAS scores were recorded at 6 h, 12 h, 24 h, 48 h and 72 h after the operation, and the knee joint mobility and incidence of analgesic side effects were recorded.Results At 6 h, 12 h, 24 h, 48 h and 72 h after the operation stationary VAS scores of patients in group A were respectively on average 1.2 ± 0.66, 1.91 ± 0.63, 2.12 ± 0.56, 2.53 ± 0.31 and 2.24 ± 0.44, which in group B were 2.15 ± 0.59, 2.50 ± 0.49, 3.72 ± 0.45, 3.54 ± 0.38 and 3.23 ± 0.48. The stationary VAS scores at each time points were not statistically signiifcantly different between the 2 groups (P > 0.05 ). Postoperative 12 h, 24 h, 48 h, average moving VAS scores of patients in group A were separately 4.91 ± 0.63, 4.12 ± 0.76, 3.73 ± 0.31, which in group B were separately 5.90 ± 0.49, 6.52 ± 0.45, 5.34 ± 0.38. There were statistically significant differences (P < 0.05 ).The incidence of nausea, vomiting and constipation in patients of group A postoperatively were 4.65% and 6.98% respectively, which were 25.6% and 23.3% in group B respectively. The differences were statistically significant (P < 0.05 ). In 3 to 5 days after the operation, patients of group A with knee joint activity were respectively ( 50.7 ± 7.3 ) °, ( 67.4 ± 8.3 ) ° and ( 84.7 ± 9.2 ) °, and patients of group B with knee joint activity were respectively ( 46.8 ± 10.3 ) °, ( 57.9 ± 9.5 ) ° and ( 73.6 ± 10.1 ) °. The differences were statistically signiifcant (P < 0.05 ). The satisfaction was 79.1% in group A, which was 58.1% in group B, and the differences were statistically signiifcant (P < 0.05 ). Conclusions Preemptive analgesia combined with multimodal analgesia can achieve satisfactory analgesia after total knee arthroplasty. Injection with mixed analgesics around the knee joint combined with postoperative continuous femoral nerve block achieves better analgesic effects than injection with mixed analgesics around the knee joint combined with patient-controlled intravenous analgesia pump. The side effects of analgesic drugs are less, and patients are more satisifed.