Department of Orthopedic & Traumatology, Cipto Mangunkusumo General Hospital, Universitas Indonesia, DKI Jakarta, Indonesia.
Universitas Pattimura, Maluku, Indonesia.
Pain Physician. 2021 Dec;24(8):E1199-E1204.
Adequate pain management has an important role in supporting early ambulation after total knee arthroplasty (TKA). Multimodal analgesia is one of the modalities of overcoming postoperative pain. The use of a combination of paracetamol and ibuprofen is expected to reduce the total morphine requirement after TKA.
The use of a combination of paracetamol and ibuprofen to reduce morphine requirement after TKA, to provide adequate pain management and early ambulation.
Patients scheduled for total knee arthroplasty who met the requirements for inclusion criteria were consented and randomized using randomizer.org in a 1:1:1 ratio to receive either combination paracetamol iv and ibuprofen iv (Group II), paracetamol iv only (Group II), or ibuprofen iv only (III).
Thirty-six patients aged 63-68 years who underwent TKA were included in this study.
All patients were divided into 3 groups. Group I received paracetamol 1 g and ibuprofen 800 mg, group II received 1 g paracetamol iv and 100 mL normal saline, group III received 800 mg ibuprofen iv and 100 mL normal saline, 10 minutes before the end of surgery and every 6 hours up to 24 hours. Total morphine consumption, pain score (resting, walking, knee flexion), and 2 minute-length walking tests were measured in hour 24 postoperative. Data were analyzed with SPSS 16.0.
Median of total morphine consumption between 3 groups respectively was 7.5 (3.0-36.0) mg vs 15.0 (4.5-28.5) mg vs 9.0 (0.0-24.0) mg with no difference (P = 0.391). Mean of pain score at walking phase respectively was 4.8 ± 0.5 vs 7.3 ± 1.2 vs 5.6 ± 0.5 (hour 24, P < 0.01). Medians of 2-Minute Walking Test respectively were 6.0 (2-16) meters vs 0.0 (0-4) meters vs 0.0 (0-4) meters (hour 24, P < 0.01).
The total morphine requirement measured in this study illustrates the consumption of morphine in resting phase.
The combination of paracetamol and ibuprofen is better in reducing the total morphine requirement after TKA when compared with the administration of paracetamol injection alone or ibuprofen injection alone. Combination paracetamol injection and ibuprofen injection also provides adequate pain management in order to help early ambulation.
充分的疼痛管理在全膝关节置换术后早期活动中起着重要作用。多模式镇痛是克服术后疼痛的一种方式。联合使用对乙酰氨基酚和布洛芬有望减少 TKA 后的吗啡总需求量。
联合使用对乙酰氨基酚和布洛芬可减少 TKA 后的吗啡需求，以提供充分的疼痛管理和早期活动。
符合纳入标准的拟行全膝关节置换术的患者同意并使用 randomizer.org 以 1:1:1 的比例随机分为三组，分别接受联合静脉注射对乙酰氨基酚和布洛芬（组 II）、单独静脉注射对乙酰氨基酚（组 II）或单独静脉注射布洛芬（III）。
36 名年龄在 63-68 岁之间接受 TKA 的患者纳入本研究。
所有患者分为 3 组。第 I 组给予对乙酰氨基酚 1g 和布洛芬 800mg，第 II 组给予 1g 对乙酰氨基酚静脉注射和 100mL 生理盐水，第 III 组给予 800mg 布洛芬静脉注射和 100mL 生理盐水，均在手术结束前 10 分钟和术后 24 小时内每 6 小时给予一次。术后 24 小时测量总吗啡消耗量、疼痛评分（休息时、行走时、膝关节弯曲时）和 2 分钟步行试验。使用 SPSS 16.0 分析数据。
三组的总吗啡消耗量中位数分别为 7.5（3.0-36.0）mg 比 15.0（4.5-28.5）mg 比 9.0（0.0-24.0）mg，差异无统计学意义（P = 0.391）。第 24 小时行走时疼痛评分的平均值分别为 4.8 ± 0.5 比 7.3 ± 1.2 比 5.6 ± 0.5（P < 0.01）。2 分钟步行试验的中位数分别为 6.0（2-16）米比 0.0（0-4）米比 0.0（0-4）米（P < 0.01）。
本研究测量的总吗啡需求量说明在休息阶段吗啡的消耗量。
与单独使用对乙酰氨基酚注射或单独使用布洛芬注射相比，联合使用对乙酰氨基酚和布洛芬可更好地减少 TKA 后的总吗啡需求量。联合使用对乙酰氨基酚注射和布洛芬注射还可以提供充分的疼痛管理，以帮助早期活动。
