预防性镇痛给药时机对老年膝关节置换术后的镇痛效果影响及安全性研究

Efficacy and safety of different timings of celecoxib on preventive analgesia in elderly patients after total knee arthroplasty

目的探讨老年患者全膝关节置换术(TKA)术前预防性镇痛不同给药时机的镇痛效果及安全性。方法选取2020年6月至2021年9月拟行单侧TKA的老年患者96例,根据剔除标准,实际共93例患者完成研究并纳入分析,将其分为A组(30例)、B组(32例)、C组(31例)。A组术前3 d连续口服塞来昔布,每天2次,每次200 mg;B组术前12 h顿服塞来昔布200 mg;C组术前2 h顿服塞来昔布200 mg。随访至术后72 h,比较3组患者术后第4、12、24、36、48、72小时静态及动态疼痛视觉模拟评分法(VAS)评分,第48、72小时膝关节最大屈曲度,镇痛补救情况及相关不良反应。结果3组患者术后VAS评分均随时间延长而降低,不同时间点间差异有统计学意义(P<0.05);A组和C组术后12、24 h静态VAS评分低于B组(P<0.05)。A组和C组术后第48、72小时膝关节最大屈曲度均高于同时间点B组(P<0.05);A组和C组间差异无统计学意义(P>0.05)。术后因疼痛追加曲马多注射液的例次B组高于A组和C组(P<0.05)。B组恶心、头晕的发生率高于A组和C组(P<0.05);A组患者出现腹痛的例次多于B组和C组(P<0.05)。结论老年患者TKA术前2 h口服塞来昔布200 mg有助于术后早期疼痛控制和功能恢复,且安全性好。

Objective To evaluate the efficacy and safety of different timings of celecoxib on preventive analgesia in elderly patients with total knee arthroplasty(TKA).Methods A total of 96 patients undergoing TKA during June 2020 and June 2021 were selected according to different timings of celecoxib on preventive analgesia.According to the exclusion criteria,a total of 93 patients completed the study and were included in the analysis.They were divided into group A(30 cases),group B(32 cases)and group C(31 cases).Group A took celecoxib for 3 d preoperatively(200 mg bid).Group B took celecoxib 12 h before the preoperatively(200 mg once).Group C took celecoxib 2 h before the preoperatively(200 mg once).Visual analogue scale(VAS)of all patients for pain during activity and at rest,maximal flexion degree of the knee at the 48th h and the 72th h after surgery,and complications were evaluated and analyzed.Results The postoperative VAS scores of the 3 groups were decreased with the extension of time,and the differences among different time points were statistically significant(P<0.05).VAS for pain at rest of patients in the group A and group C was significantly less than that in the group B at the 12th h,and 24th h after surgery(all P<0.05).Maximal flexion degree of the knee at the 48th h and the 72th h after surgery in the group A and group C were better than those in the group B(all P<0.05).No significant difference was found between group A and group C(P>0.05).Cases of additional tramadol injection and the incidence rates of nausea and dizziness in group B were significantly higher than that in group A and group C(P<0.05).The incidence rates of stomachache in group A were significantly higher than that in group B and group C(P<0.05).Conclusion Giving a preoperative dose of 200 mg oral celecoxib can strongly relieve the pain early after TKA,which can improve knee function and achieve painless rehabilitation in elderly patients,with safety.