Wang Qiuru, Li Xingcheng, Hu Jian, Chen Changjun, Yang Jing, Kang Pengde
Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan, 610041, People's Republic of China.
Department of Nephrology, West China Tianfu Hospital, West China School of Nursing, Sichuan University, No. 3966 Tianfu Avenue, Chengdu, 610200, China.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):23. doi: 10.1007/s00402-024-05621-x.
Preemptive multimodal analgesia (PMA) is commonly employed for pain control after total knee arthroplasty (TKA). However, the optimal timing for initiating PMA remains unclear. This study aimed to compare the efficacy of PMA administered at different time points before TKA.
In this prospective, double-blind, placebo-controlled, randomized trial, 120 patients who underwent TKA were randomized into three groups. PMA (200 mg celecoxib and 150 mg pregabalin administered every 12 h) was initiated 48 h (group A), 24 h (group B), and 1 h (group C) before surgery. The primary outcome was the postoperative administration of morphine hydrochloride as a rescue analgesic. Secondary outcomes included time to first rescue analgesia, postoperative pain assessed using the visual analog scale (VAS), functional recovery assessed by knee motion range and ambulation distance, time until hospital discharge, and complication rates.
Compared with group C, groups A and B exhibited significantly lower morphine consumption within 24 h after surgery, lower total morphine consumption, longer time to first rescue analgesia, and superior range of knee motion on the day of surgery. Groups A and B did not exhibit significant differences in these outcomes. The three groups did not differ significantly in postoperative VAS pain scores, ambulation distance, length of hospital stay, or complication rates.
In comparison with PMA starting at 1 h preoperatively, initiating PMA at 24 and 48 h preoperatively provided better postoperative pain relief. Considering the aim of minimizing the amount of ineffective medication received by patients, initiating PMA at 24 h preoperatively may be a more favorable option for patients undergoing TKA. However, the clinical significance of our results and the optimal starting time for PMA require further investigation.
全膝关节置换术（TKA）后，预防性多模式镇痛（PMA）常用于控制疼痛。然而，启动PMA的最佳时机仍不明确。本研究旨在比较在TKA前不同时间点给予PMA的疗效。
在这项前瞻性、双盲、安慰剂对照、随机试验中，120例行TKA的患者被随机分为三组。术前48小时（A组）、24小时（B组）和1小时（C组）开始给予PMA（每12小时服用200毫克塞来昔布和150毫克普瑞巴林）。主要结局是术后给予盐酸吗啡作为补救镇痛药。次要结局包括首次补救镇痛的时间、使用视觉模拟量表（VAS）评估的术后疼痛、通过膝关节活动范围和步行距离评估的功能恢复、出院时间以及并发症发生率。
与C组相比，A组和B组术后24小时内的吗啡消耗量显著更低，总吗啡消耗量更低，首次补救镇痛的时间更长，且手术当天膝关节活动范围更大。A组和B组在这些结局方面没有显著差异。三组在术后VAS疼痛评分、步行距离、住院时间或并发症发生率方面没有显著差异。
与术前1小时开始使用PMA相比，术前24小时和48小时开始使用PMA能提供更好的术后疼痛缓解。考虑到尽量减少患者无效药物用量的目标，对于接受TKA的患者，术前24小时开始使用PMA可能是更有利的选择。然而，我们结果的临床意义以及PMA的最佳起始时间需要进一步研究。
