Preoperative application of alprazolam for patients with anxiety and depression and pain after total knee arthroplasty: its safety and effectiveness

doi:10.3969/j.issn.2095-4344.2017.07.001

Abstract

Abstract:

BACKGROUND: Psychological factors could influence the degree of pain after total knee arthroplasty. However, the effects of perioperative psychological intervention on postoperative pain and joint function are rarely reported.

OBJECTIVE: To study the efficacy and safety of alprazolam for patients with anxiety and depression before total knee arthroplasty.

METHODS: Sixty-one patients with anxiety and depression before unilateral total knee arthroplasty were recruited. The patients were given the treatment of alprazolam (experimental group) or placebo (control group) at 2 weeks preoperatively. Baseline data were collected, preoperative anxiety and depression were assessed with Hamilton Anxiety Scale and Beck Depression Inventory, perioperative pain at rest and in activity at each time point was evaluated, postoperative NSAIDs drugs and intravenous self-control analgesia pump usage were recorded, the peripheral neurotransmitters were detected by ELISA, short- and mediate-term joint fuction was evaluated through Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score after joint replacement, patient satisfaction and in-hospital relevant indexes and adverse reactions were detected.

RESULTS AND CONCLUSION: (1) After the application of alprazolam, anxiety and depression were improved notablely, and the levels of 5-hydroxytryptamine and γ-aminobutyric acid in peripheral blood were increased at 2 weeks. (2) The visual analogue scale scores at rest in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, 5 and 7 days postoperatively (P < 0.05); the visual analogue scale scores in activity in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, and 5 days postoperatively (P < 0.05). (3) Analgesia pump and analgesic drug usage in the experiemntal group were significantly less than those in the control group, and the analgesic drug dosage and preoperative anxiety depression were correlated. (4) There were no significant differences in the Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score between two groups. (5) The patient satisfaction, sleep index and hospitation time in the experimental group were superior to those in the control group. No obvious adverse reactions occurred during medication. (6) Our results suggest that for patients diagnosised with anxiety and depression before total knee replacement, the preoperative application of alprazolam can alleviate anxiety and depression, improve perioperative pain at rest and in activity, reduce postoperative analgesia drug useage, and increase patient satisfaction.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Knee, Alprazolam, Pain, Anxiety, Depression, Tissue Engineeirng

CLC Number:

R318

Liang Xin, Wang Heng, Li Xian-rong. Preoperative application of alprazolam for patients with anxiety and depression and pain after total knee arthroplasty: its safety and effectiveness [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 985-992.

Figures/Tables 9

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