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Wang Q, Hu J, Ye S, Yang J, Kang P. Efficacy of Oral Nefopam on Multimodal Analgesia in Total Knee Arthroplasty: A Prospective, Double-Blind, Placebo-Controlled, Randomized Trial. J Arthroplasty 2024; 39:2061-2067. [PMID: 38403077 DOI: 10.1016/j.arth.2024.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Multimodal analgesia is central to pain management after total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding oral nefopam to multimodal analgesia for post-TKA pain management. METHODS In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients who underwent TKA at our hospital were randomized to either the nefopam or the control group. After surgery, patients in the nefopam group received 200 mg of celecoxib, 150 mg of pregabalin, and 40 mg of nefopam twice daily to control postoperative pain. Patients in the control group received 200 mg of celecoxib, 150 mg of pregabalin, and a placebo. Oxycodone hydrochloride (10 mg) was used as the rescue analgesic. If the pain remained poorly controlled, 10 mg of morphine hydrochloride was injected subcutaneously as a secondary rescue analgesic. The primary outcome was the postoperative consumption of oxycodone and morphine as rescue analgesics. Secondary outcomes were postoperative pain assessed using the visual analogue scale (VAS), functional recovery assessed by the range of knee motion and ambulation distance, time until hospital discharge, indicators of liver function, and complication rates. RESULTS Patients in the nefopam group had significantly lower postoperative oxycodone and morphine consumption within 24 hours after surgery and during hospitalization, lower VAS pain scores at rest and during motion within 24 h after surgery, better functional recovery on postoperative days 1 and 2, and a shorter hospital stay. However, the absolute reduction in 0 to 24 h opioid consumption, VAS pain scores, and knee range of motion did not exceed the reported minimal clinically important difference. Both groups had similar indicators of liver function and complication rates. CONCLUSIONS Adding oral nefopam to multimodal analgesia resulted in statistically significant improvements in opioid consumption, VAS pain scores, and functional recovery. However, the amount of improvement may not be clinically important.
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MESH Headings
- Humans
- Nefopam/administration & dosage
- Nefopam/therapeutic use
- Double-Blind Method
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Arthroplasty, Replacement, Knee/adverse effects
- Male
- Female
- Aged
- Middle Aged
- Prospective Studies
- Oxycodone/administration & dosage
- Oxycodone/therapeutic use
- Celecoxib/administration & dosage
- Celecoxib/therapeutic use
- Pain Measurement
- Pain Management/methods
- Treatment Outcome
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Administration, Oral
- Pregabalin/therapeutic use
- Pregabalin/administration & dosage
- Morphine/administration & dosage
- Morphine/therapeutic use
- Drug Therapy, Combination
- Analgesia/methods
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Affiliation(s)
- Qiuru Wang
- Department of Orthopedic surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jian Hu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Shuwei Ye
- Department of Orthopedic surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pengde Kang
- Department of Orthopedic surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Ye S, Wang Q, Zhao C, Li Q, Cai L, Kang P. Effects of a Modified Long-Acting Cocktail on Analgesia and Enhanced Recovery After Total Hip Arthroplasty: A Double-Blinded Randomized Clinical Trial. J Arthroplasty 2024:S0883-5403(24)00452-2. [PMID: 38735542 DOI: 10.1016/j.arth.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND We compared the efficacy and safety of a modified cocktail for postoperative analgesia and early functional rehabilitation in patients undergoing total hip arthroplasty (THA). METHODS Magnesium sulfate and sodium bicarbonate were added to a cocktail of ropivacaine, epinephrine, and dexamethasone. Primary outcome measures were visual analog scale (VAS) pain scores at various intervals after surgery, morphine consumption for rescue analgesia after surgery, and time to first rescue analgesia. Secondary outcomes were hip function after surgery, daily walking distance, quadriceps muscle strength, and the incidence of postoperative adverse reactions. RESULTS Morphine consumption was significantly lower in the modified cocktail group than in the control group in the first 24 hours after surgery (6.2 ± 6.0 versus 14.2 ± 6.4 mg, P < .001), as was total morphine consumption (10.0 ± 8.6 versus 19.2 ± 10.1 mg, P < .001). The duration of the first rescue analgesia was significantly prolonged (23.7 ± 10.3 versus 11.9 ± 5.8 mg, P < .001). Morphine consumption was also reduced in the magnesium sulfate and sodium bicarbonate groups over a 24-hour period compared to the control group (P < .001). The modified cocktail group had significantly lower resting VAS pain scores than the control group within 24 hours after surgery (P < .050). The VAS pain scores during movement within 12 hours after surgery were also lower (P < .050). The experimental groups showed better hip range of motion (P < .050) and longer walking distance (P < .050) on the first postoperative day, and levels of inflammatory markers were significantly reduced. The incidence of postoperative adverse reactions was similar among the 4 groups. CONCLUSIONS The modified cocktail with a new adjuvant can prolong the duration of postoperative analgesia, reduce the dosage of rescue analgesics, and accelerate early postoperative functional recovery in patients undergoing THA.
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Affiliation(s)
- Shuwei Ye
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuru Wang
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chengcheng Zhao
- Orthopedics Ward, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
| | - Qianhao Li
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lijun Cai
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
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Li J, Dong Y, Guo J, Wang L, Tian J, Wang L, Che G. Thoracoscopic Intercostal Nerve Block with Cocktail Analgesics for Pain Control After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study. J Pain Res 2024; 17:1183-1196. [PMID: 38524689 PMCID: PMC10959176 DOI: 10.2147/jpr.s446951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To evaluate whether using a cocktail of intercostal nerve blocks (TINB) during thoracoscopic surgery results in better clinical outcomes than patient-controlled analgesia (PCIA). Methods Patients in two medical groups undergoing video-assisted thoracoscopic surgery (VATS) for pulmonary nodules in West China Hospital of Sichuan University were collected consecutively between March 2022 and December 2022. The groups were divided into two subgroups based on their analgesic program, which were TINB group and PCIA group. The primary outcome was the visual analogue scale (VAS) of the two groups at different stage after surgery and after discharge. Any analgesic related adverse events (ARAEs) were also recorded. Results A total of 230 patients who underwent VATS were enrolled, in which 113 patients (49.1%) received a cocktail TINB after surgery, and 117 patients (50.9%) received a PCIA. After PSM, 62 patients in each group were selected. The difference of resting VAS (RVAS) and active VAS (AVAS) at different stage during hospitalization was only related to the change of period (p < 0.05, p < 0.05), and the two groups showed no significant differences in RVAS or AVAS during hospitalization (p = 0.271, p = 0.915). However, the rates of dizziness (4.84% vs 25.81%, p = 0.002), nausea and vomiting (0 vs 22.58%, p < 0.05), fatigue (14.52% vs 34.87%, p = 0.012), and insomnia (0 vs 58.06%, p < 0.05) in TINB group were lower than that in PCIA group. Besides, AVAS and RVAS at 7, 14, and 30 days after discharge in TINB group were both significantly lower than that in PCIA group (p < 0.05, p < 0.05). Conclusion Cocktail TINB provided better analgesia after discharge and reduced the incidence of ARAEs in patients undergoing VATS.
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Affiliation(s)
- Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jiawei Guo
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People’s Republic of China
| | - Lei Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jie Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Li Wang
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People’s Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Jiao S, Feng Z, Dai T, Huang J, Liu R, Meng Q. High-Intensity Progressive Rehabilitation Versus Routine Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2024; 39:665-671.e2. [PMID: 37634879 DOI: 10.1016/j.arth.2023.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND This study aimed to compare the effectiveness of high-intensity progressive rehabilitation training with routine training in the early treatment of patients undergoing total knee arthroplasty. METHODS There were 78 patients who underwent total knee arthroplasty and were randomized into high-intensity progressive training and routine rehabilitation training groups (RRT). The primary outcome measures were the American Hospital for Special Surgery Knee Score (HSS), with secondary outcomes including patient satisfaction, visual analog pain score, first time of standing after surgery, 6-minute walk test, 36-Item Short Form Survey (SF-36), and length of hospital stay. The incidence of postoperative complications were recorded. RESULTS The HSS scores were higher in the intervention group at 2 weeks, 3 months, and 12 months postoperatively (P < .001). The RRT group had higher visual analog pain scores than the intervention group at 24 hours, 3 days, and 2 weeks after surgery (P < .001). The intervention group had an earlier the first time of standing after surgery and a longer 6-minute walk test distance (P < .001, P = .028, P < .001, P < .001). Patient satisfaction was higher in the intervention group, with a higher quality of life rating at 3 months postoperatively (P < .001). However, 1 year after surgery, the 2 groups had no significant differences in mental component summaries. The length of hospital stay was shorter in the intervention group than in the RRT group. CONCLUSION Compared to routine training, high-intensity progressive rehabilitation training is more effective. It reduces postoperative patient pain, accelerates recovery of joint function, increases patient satisfaction, improves quality of life, shortens hospital stays, and promotes rapid recovery.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Tianming Dai
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Hubei, China
| | - Ruijia Liu
- Department of Orthopedics, Foshan Fosun Chancheng Hospital, Foshan, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
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Legnani C, Torretta E, Attanasio M, Gelfi C, Parente F, Ventura A, Oriani G. Safety of blood reinfusion drains after local infiltration analgesia in total joint replacement. BMC Musculoskelet Disord 2024; 25:170. [PMID: 38395809 PMCID: PMC10885553 DOI: 10.1186/s12891-024-07261-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Local infiltration analgesia (LIA) is frequently administered to patient undergoing joint replacement surgical procedures. The aim of the present research was to verify the safety of collected shed blood to be reinfused postoperatively, by measuring levobupivacaine levels in drainage blood in patients undergoing LIA during knee replacement surgery. PATIENTS AND METHODS 24 patients who underwent total knee arthroplasty (TKA) and 12 scheduled for total hip arthroplasty (THA) who received intraoperative LIA were considered. Blood samples were collected from shed blood which was present in drainage 2 and 5 hours after surgery and serum was analysed by liquid chromatography-tandem mass spectrometry. RESULTS At 2 hours postoperatively, the median levobupivacaine serum concentration in the collected shed blood was 1.2 mg/L (SD: 4.2) for TKA and 17.13 mg/L (SD: 24.4) for THA. At 5 hours, levobupivacaine concentration was 1.84 mg/L (SD: 2.2) for TKA and 17.5 mg/L (SD: 25.2) for THA. Higher values of average serum levobupivacaine concentration were reported in drains collected from patients who had undergone THA compared to TKA (p<0.001). BMI significantly influenced levels of serum drug, that resulted to be higher in patients with BMI<25 (p= 0.01). CONCLUSION Levobupivacaine from collected shed blood that would have been returned to the patient, was below toxicity level at 2 and 5 hours after LIA during total joint replacement. The average serum levobupivacaine concentration was found to be higher in drains taken from THA patients than TKA patients. Patients with lower BMI demonstrated the highest levels of levobupivacaine in shed blood and a lower blood volume needed for central nervous system toxicity. Therefore, in patients with a lower BMI undergoing THA, anaesthetic dosage should be reduced or autotransfusion should be avoided to prevent potential risks of toxicity.
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Affiliation(s)
- Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy.
| | - Enrica Torretta
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Proteomics and Lipidomics, Milan, Italy
| | - Marco Attanasio
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Cecilia Gelfi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Proteomics and Lipidomics, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Franco Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy
| | - Giorgio Oriani
- IRCCS Istituto Ortopedico Galeazzi, Department of Anesthesiology, Milan, Italy
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Yu D, Wu Y, Han S, Wang X, Jiang L. Analgesic efficacy of local infiltration anaesthesia versus femoral nerve block in alleviating postoperative wound pain following total knee arthroplasty: A systematic review and meta-analysis. Int Wound J 2024; 21:e14766. [PMID: 38351465 PMCID: PMC10864686 DOI: 10.1111/iwj.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
Total knee arthroplasty (TKA) often involves significant postoperative pain, necessitating effective analgesia. This meta-analysis compares the analgesic efficacy of local infiltration anaesthesia (LIA) and femoral nerve block (FNB) in managing postoperative wound pain following TKA. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis was structured around the PICO framework, assessing studies that directly compared LIA and FNB in TKA patients. A comprehensive search across PubMed, Embase, Web of Science and the Cochrane Library was conducted without time restrictions. Studies were included based on specific criteria such as participant demographics, study design and outcomes like pain scores and opioid consumption. Quality assessment utilized the Cochrane Collaboration's risk of bias tool. The statistical approach was determined based on heterogeneity, with the choice of fixed- or random-effects models guided by the I2 statistic. Sensitivity analysis and evaluation of publication bias using funnel plots and Egger's linear regression test were also conducted. From an initial pool of 1275 articles, eight studies met the inclusion criteria. These studies conducted in various countries from 2007 to 2016. The meta-analysis showed no significant difference in resting and movement-related Visual Analogue Scale scores post-TKA between the LIA and FNB groups. However, LIA was associated with significantly lower opioid consumption. The quality assessment revealed a low risk of bias in most studies, and the sensitivity analysis confirmed the stability of these findings. There was no significant publication bias detected. Both LIA and FNB are effective in controlling postoperative pain in TKA patients, but LIA offers the advantage of lower opioid consumption. Its simplicity, cost-effectiveness and opioid-sparing nature make LIA the recommended choice for postoperative analgesia in knee replacement surgeries.
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Affiliation(s)
- Dongdong Yu
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Yajing Wu
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Shuang Han
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Xiaoyu Wang
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Li Jiang
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
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Villa JM, Hosseinzadeh S, Higuera-Rueda CA. What's New in Adult Reconstructive Knee Surgery. J Bone Joint Surg Am 2024; 106:93-101. [PMID: 37973029 DOI: 10.2106/jbjs.23.01054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Jesus M Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
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Wang Z, Wang F, Li Y, Xing Y, Jiang X, Li C, Ding Z, Tang L. Analgesic effect of nitrous oxide during manual therapy after anterior cruciate ligament reconstruction: a study protocol for a randomized controlled trial. Trials 2023; 24:764. [PMID: 38012761 PMCID: PMC10683199 DOI: 10.1186/s13063-023-07732-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Many patients during manual therapy after anterior ligament reconstruction will experience severe pain, which has a negative impact on their rehabilitation. However, there is rarely an analgesic method for these patients during rehabilitation. Nitrous oxide with rapid analgesic and sedative effects is often used to relieve pain in minor procedures. The purpose of this study is to determine whether or not nitrous oxide analgesia decreases pain compared to oxygen during manual therapy after anterior ligament reconstruction. METHODS/DESIGN This single-center, randomized, double-blind and controlled trial will recruit 120 patients. Patients ≥ 18 years old undergoing manual therapy after anterior ligament reconstruction (1 month post-operative) with acute pain (VAS ≥ 4) are included. The main exclusion criteria included the following: pulmonary embolism, intestinal obstruction, pneumothorax. Patients will be randomly allocated to the intervention group (A) and the control group (B) in a ratio of 1:1. Doctors, therapists, patients, and data collectors are all blind to the study. The manual therapy will be performed by therapists. Nurses who implemented the intervention handed the doctors envelopes containing the patients' codes and allocation of A or B. Group A will receive a pre-prepared nitrous oxide/oxygen mixture plus conventional treatment (no analgesic) given as 30-min treatment sessions, once daily, and group B will receive oxygen plus conventional treatment (no analgesic) under the same conditions. Assessments will be taken 2 min before the intervention (T0), 5 min after the beginning of the intervention (T1), and 5 min after the intervention finished (T2). The primary outcome is pain score. Secondary outcomes include vital signs, side effects, joint range of motion, adjuvant analgesia need, therapist and patient satisfaction, and whether willing to receive the same gas again. EXPECTED OUTCOMES We expect nitrous oxide inhalation to have a beneficial effect on the pain of patients who receive manual therapy after anterior ligament reconstruction. DISCUSSION If this treatment appears beneficial, it could improve patients' satisfaction and quality of life potentially and even be implemented widely in hospital and rehabilitation settings. TRIAL REGISTRATION ClinicalTrials.gov identifier, ChiCTR2200061175 (Version 2.0 June 15, 2022), https://www.chictr.org.cn .
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Affiliation(s)
- Ziyang Wang
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Fei Wang
- Department of Anesthesiology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
| | - Yuxiang Li
- School of Nursing, Ningxia Medical University, Ningxia, Yinchuan, China
| | - Yihui Xing
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Xiaochen Jiang
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Cui Li
- Department of Rehabilitation Medicine, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
| | - Zhiguo Ding
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Lu Tang
- School of Nursing, Weifang Medical University, Weifang, Shandong, China.
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Wang Q, Ma T, Wang L, Zhao C, Kang P. Efficacy of Adding Acetaminophen to Preemptive Multimodal Analgesia in Total Knee Arthroplasty: A Double-blinded Randomized Study. Orthop Surg 2023; 15:2283-2290. [PMID: 37403525 PMCID: PMC10475677 DOI: 10.1111/os.13780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Preemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA. METHODS This was a double-blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann-Whitney U test, respectively. Categorical variables were compared by the Pearson's chi-squared test. RESULTS The control and acetaminophen groups were comparable in postoperative 0-24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications. CONCLUSIONS In this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Ting Ma
- Operating RoomWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Liying Wang
- Operating RoomWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Chengcheng Zhao
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Pengde Kang
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
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