Abstract:

BACKGROUND: There are many multimodal analgesia schemes in perioperative period of total knee arthroplasty, but there is no ideal scheme.
OBJECTIVE: To explore the effects of multi-mode and preemptive analgesia on analgesic effect after total knee arthroplasty.
METHODS: 120 patients with severe osteoarthritis who underwent unilateral knee arthroplasty were enrolled in this study. According to different analgesic effects, the patients could be divided into four groups (n=30). In the control group, no corresponding analgesic measures were found before and during replacement. In the preemptive analgesia group, celecoxib was orally taken before replacement. In the cocktail analgesia group, cocktail was periarticularly injected during replacement. In the multimodal combined analgesia group, celecoxib was orally taken before replacement + cocktail was periarticularly injected during replacement. After replacement, intravenous patient-controlled analgesia pump was applied in each group. Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were measured at various time points after total knee arthroplasty in four groups. Adverse reactions were recorded after replacement.
RESULTS AND CONCLUSION: Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were better in the preemptive analgesia, cocktail analgesia and  
multimodal combined analgesia groups than in the control group at various time points after replacement (all P < 0.05). Above indexes were better in the multimodal combined analgesia group than in the preemptive analgesia and cocktail analgesia groups (all P < 0.05). No significant difference in above indexes was detected between the preemptive analgesia and cocktail analgesia groups (all P > 0.05). No significant difference in the number of cases affecting nausea and vomiting was detected at 2 weeks after replacement in the four groups (P > 0.05). There was no deep venous thrombosis of double lower limbs or necrosis and infection of incision. These findings suggest that the effects of preemptive analgesia before total knee arthroplasty, local injection analgesia during replacement, and the combined analgesia of intravenous patient-controlled analgesia pump after replacement were ideal. Adverse reactions did not increase, and the operation was safe. At present, multimodal combined analgesia has been accepted by us, but to achieve truly painless results after total knee arthroplasty still needs more efforts.
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, Analgesia, Osteoarthritis, Knee, Tissue Engineering