Department of Anesthesia, Sunnybrook Holland Orthopedic and Arthritic Centre, Toronto, Ontario, Canada.
Pain Res Manag. 2013 May-Jun;18(3):127-32. doi: 10.1155/2013/258714.
Despite the success of total hip arthroplasty (THA), some patients experience persistent pain and poor function after surgery. Predictors of poor outcomes include the presence of significant pre- and postoperative pain. Patients undergoing THA often experience severe, long-standing pain before surgery that may compromise the outcome of the procedure.
To evaluate the effects of administering pregabalin and celecoxib for two weeks before and three weeks after THA in patients with moderate to severe pain before surgery. The aim was to determine whether patients with well-controlled pain both before surgery and in the acute postoperative period experience less pain and better physical function six weeks after THA.
A randomized, double-blinded, placebo-controlled pilot study was conducted. Group 1 received pregabalin (75 mg twice per day) and celecoxib (100 mg twice per day) for 14 days before THA and for three weeks after discharge. Group 2 received a placebo for the same duration. All patients received pregabalin and celecoxib 2 h before surgery and while in the hospital.
On the morning of surgery, patients in group 1 reported less pain at rest (mean [± SD] pain intensity measured on a visual analogue scale [VAS] 2.1±1.4) compared with group 2 (3.3±1.9; P=0.04). Patients in group 1 experienced less pain 3 h to 4 h postoperation (P<0.001). There was no difference in morphine consumption between the two groups. Six weeks after THA, movement-evoked pain was lower in group 1 (VAS 0.8±0.6) compared with group 2 (VAS 2.0±1.3; P=0.01). Group 1 reported better physical function, measured using the Western Ontario and McMaster University Osteoarthritis Index questionnaire score (P=0.04). There was no significant difference in 6 min walk test performance between the two groups.
Intensive pain control with pregabalin and celecoxib improves pain and physical function after THA.
尽管全髋关节置换术（THA）取得了成功，但仍有部分患者在术后存在持续疼痛和功能不佳的情况。不良结局的预测因素包括术前和术后存在明显疼痛。接受 THA 的患者在手术前通常会经历严重且长期的疼痛，这可能会影响手术的结果。
评估在术前 2 周和术后 3 周给予普瑞巴林和塞来昔布治疗对术前中度至重度疼痛患者的影响。目的是确定术前疼痛控制良好且在急性术后期间疼痛得到控制的患者在 THA 后 6 周时疼痛是否减轻，身体功能是否改善。
进行了一项随机、双盲、安慰剂对照的初步研究。第 1 组患者在 THA 前 14 天和出院后 3 周内每天接受普瑞巴林（75 mg，每日两次）和塞来昔布（100 mg，每日两次）治疗。第 2 组患者在相同的时间段内接受安慰剂治疗。所有患者在手术前 2 小时和住院期间均接受普瑞巴林和塞来昔布治疗。
手术当天早上，第 1 组患者报告静息时疼痛程度较轻（使用视觉模拟量表 [VAS] 测量的平均 [± SD] 疼痛强度为 2.1±1.4），而第 2 组患者为 3.3±1.9；P=0.04）。第 1 组患者术后 3 至 4 小时疼痛程度较轻（P<0.001）。两组患者的吗啡消耗量无差异。THA 后 6 周时，第 1 组患者运动诱发的疼痛程度较低（VAS 0.8±0.6），而第 2 组患者为 2.0±1.3；P=0.01）。第 1 组患者使用西安大略和麦克马斯特大学骨关节炎指数问卷评分报告身体功能更好（P=0.04）。两组患者 6 分钟步行试验表现无显著差异。
使用普瑞巴林和塞来昔布进行强化疼痛控制可改善 THA 后的疼痛和身体功能。
