西乐葆在膝关节成形术中的镇痛管理

xgw1968

Background

   Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. We evaluated opioid-sparing effects and rehabilitative results after perioperative celecoxib administration for total knee arthroplasty.

Methods

   This was a prospective, randomized, observer-blind control study. Eighty patients that underwent total knee arthroplasty were randomized into two groups of 40 each. The study group received a single 400mg dose of celecoxib, one hour before surgery, and 200mg of celecoxib every 12 hours for five days, along with patient-controlled analgesic (PCA) morphine. The control group received only PCA morphine for postoperative pain management. Visual analog scale (VAS) pain scores, active range of motion (ROM), total opioid use and postoperative nausea/vomiting were analyzed.

Results

   Groups were comparable for age, pre-operative ROM, operation duration and intraoperative blood loss. Resting VAS pain scores improved significantly in the celecoxib group, compared with controls, at 48 hrs (2.13 ± 1.68 vs. 3.43 ± 1.50, p=0.03) and 72 hrs (1.78 ± 1.66 vs. 3.17 ± 2.01, p=0.02) after surgery. Active ROM also increased significantly in the patients that received celecoxib, especially in the first 72 hrs [40.8° ± 17.3° vs. 25.8° ± 11.5°, p=0.01 (day 1); 60.7° ± 18.1° vs. 45.0° ± 17.3°, p=0.004 (day 2); 77.7° ± 15.1° vs. 64.3° ± 16.9°, p=0.004 (day 3)]. Opioid requirements decreased about 40% (p=0.03) in the celecoxib group. Although patients suffering from post-operative nausea/vomiting decreased from 43% in control group to 28% in celecoxib group, this was not significant (p=0.57). There were no differences in blood loss (intra- and postoperative) between the groups. Celecoxib ulted in no significant increase in the need for blood transfusions.

Conclusion
   Perioperative celecoxib significantly improved postoperative resting pain scores at 48 and 72 hrs, opioid consumption, and active ROM in the first three days after total knee arthroplasty, without increasing the risks of bleeding.

xgw1968

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