The Effectiveness of Postoperative Pain Control After Total Knee Arthroplasty in Ramathibodi Hospital: A Comparison Among Multiple Techniques
Keywords:
Total knee arthroplasty, Postoperative pain control, The effectivenessAbstract
Background: The pain control after a total knee arthroplasty (TKA) is challenging since most of the patients are elderly, often with multiple comorbidities. This study compared the effectiveness of postoperative pain control after TKA among multiple techniques.
Method: A retrospective observational study was conducted involving patients who underwent TKA and had postoperative pain management by Acute Pain Service team in Ramathibodi hospital during January and December 2010. Patients received one of four techniques including continuous femoral nerve analgesia (CFNA), intravenous patient-controlled analgesis (PCA), spinal morphine combined with as needed intravenous tramadol (SM-T), or CFNA combined with PCA (CF-PCA). The effectiveness of pain relief was quantified using numerical rating scale (NRS), the incidence of mild pain (NRS < 4), side effects and patient's satisfaction in 24 and 48 hour after the operation.
Results: One hundred and ninety-one patients (26M: 165F), age 69 8 years old, were enrolled in this study. SM-T group used additional tramadol more than others. CFNA and CF-PCA groups had lower NRS in 24 and 48 hours postoperatively [2 (0 - 7), 2 (0 - 5), 2 (0 - 4)] than SM-T [4 (0 - 10), 4.5 (0 - 5)] and PCA groups [4 (0 - 8), 3 (0 - 6)] (P < 0.05). Percentage of mild pain was highest in CFNA and CF-PCA groups. In addition, SM-T had the most incidence of nausea, vomiting and itching in first 24 hours with the lowest patient's satisfaction (P < 0.05).
Conclusion: The femoral nerve analgesia provided better postoperative pain control with fewer side effects when compared to systemic analgesic alone and spinal morphine.
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