The Effectiveness of Postoperative Pain Control After Total Knee Arthroplasty in Ramathibodi Hospital: A Comparison Among Multiple Techniques

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Published: Jun 30, 2013
Keywords:
Total knee arthroplasty Postoperative pain control The effectiveness

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Rattaphol Seangrung
Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
Nuj Tontisirin
Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Theerawat Chalacheewa
Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Chomchaba Sirinan
Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Waraporn Waikakul
Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Abstract

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 gif.latex?\pm 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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1.
Seangrung R, Tontisirin N, Chalacheewa T, Sirinan C, Waikakul W. The Effectiveness of Postoperative Pain Control After Total Knee Arthroplasty in Ramathibodi Hospital: A Comparison Among Multiple Techniques. Rama Med J [Internet]. 2013 Jun. 30 [cited 2024 Apr. 27];36(2):109-17. Available from: https://he02.tci-thaijo.org/index.php/ramajournal/article/view/102227
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Vol. 36 No. 2 (2013): April-June
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Original Articles

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