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Original Research

Open Access

Effectiveness of a multimodal analgesia protocol in the perioperative period of knee replacement surgery in men

  • Huichao Liu1
  • Xiaoyan Liu1,*,
  • Ye Li1
  • Jianying Liu1
  • Qian Li1
  • Xing Liu1

1Department of Orthopaedic, West China Hospital of Sichuan University, 610000 Chengdu, Sichuan, China

DOI: 10.22514/jomh.2024.058 Vol.20,Issue 4,April 2024 pp.104-111

Submitted: 04 February 2024 Accepted: 13 March 2024

Published: 30 April 2024

*Corresponding Author(s): Xiaoyan Liu E-mail: Liuxiaoyan_8866@163.com

Abstract

This study aimed to explore the efficacy of a multimodal analgesic regimen during the perioperative period for male patients undergoing knee replacement surgery. A total of 80 male patients scheduled for elective knee replacement surgery in our hospital’s orthopedic department from March 2022 to March 2023 were selected through digital randomization. They were equally divided into a control group (received a conventional analgesic protocol) and an observation group (treated with a multimodal analgesic protocol that included patient-controlled analgesia (PCA), ultrasound-guided nerve block and physical analgesia). Parameters such as postoperative celecoxib capsule dosage, Visual Analog Scale (VAS) scores at 6, 12, 24 and 72 hours after surgery, levels of neurotransmitters and stress markers at the time of surgery, 24 hours post-surgery, and 72 hours post-surgery, sleep quality scores, the timing of first ambulation, and the overall incidence of adverse reactions were compared between the groups. After intervention, the observation group showed a statistically significant reduction in the dosage of celecoxib capsules compared to the control group (p < 0.05). VAS scores in the observation group were significantly lower than those in the control group at all measured time points. Furthermore, levels of substance P (SP), beta-endorphin (β-EP), 5-hydroxytryptamine (5-HT), cortisol (Cor), C-reactive protein (CRP) and white blood cell (WBC) counts in the observation group were significantly lower than those in the control group at 24- and 72-hours post-surgery. The incidence of adverse reactions was also significantly lower in the observation group (p < 0.05). We conclude that implementing a multimodal analgesic protocol in the perioperative period could significantly reduce pain, regulate neurotransmitter and stress levels, and enhance sleep quality in the early postoperative phase of male patients undergoing knee replacement surgery.


Keywords

Multimodal analgesia; Men; Artificial knee replacement surgery; Pain; Stress response; Postoperative rehabilitation


Cite and Share

Huichao Liu,Xiaoyan Liu,Ye Li,Jianying Liu,Qian Li,Xing Liu. Effectiveness of a multimodal analgesia protocol in the perioperative period of knee replacement surgery in men. Journal of Men's Health. 2024. 20(4);104-111.

References

[1] Siddiqi A, Warren JA, McLaughlin J, Kamath AF, Krebs VE, Molloy RM, et al. Demographic, comorbidity, and episode-of-care differences in primary total knee arthroplasty. Journal of Bone and Joint Surgery. 2021; 103: 227–234.

[2] Hawley S, Edwards CJ, Arden NK, Delmestri A, Cooper C, Judge A, et al. Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: an analysis of UK electronic medical records. Seminars in Arthritis and Rheumatism. 2020; 50: 237–244.

[3] Schwartz AM, Farley KX, Guild GN, Bradbury TL. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. The Journal of Arthroplasty. 2020; 35: S79–S85.

[4] Le Stum M, Gicquel T, Dardenne G, Le Goff-Pronost M, Stindel E, Clavé A. Total knee arthroplasty in France: male-driven rise in procedures in 2009–2019 and projections for 2050. Orthopaedics & Traumatology: Surgery & Research. 2023; 109: 103463.

[5] Li J, Ma Y, Xiao L. Postoperative pain management in total knee arthroplasty. Orthopaedic Surgery. 2019; 11: 755–761.

[6] Zhao J, Davis SP. An integrative review of multimodal pain management on patient recovery after total hip and knee arthroplasty. International Journal of Nursing Studies. 2019; 98: 94–106.

[7] Soffin EM, Wu CL. Regional and multimodal analgesia to reduce opioid use after total joint arthroplasty: a narrative review. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery. 2019; 15: 57–65.

[8] Wang Q, Zhang W, Xiao T, Wang L, Ma T, Kang P. Efficacy of opioids in preemptive multimodal analgesia for total knee arthroplasty: a prospective, double-blind, placebo-controlled, randomized trial. The Journal of Arthroplasty. 2023; 38: 65–71.

[9] Karpetas GZ, Spyraki MK, Giakoumakis SI, Fligou FG, Megas PD, Voyagis GS, et al. Multimodal analgesia protocol for pain management after total knee arthroplasty: comparison of three different regional analgesic techniques. Journal of Musculoskeletal & Neuronal Interactions. 2021; 21: 104–112.

[10] Westrich GH, Birch GA, Muskat AR, Padgett DE, Goytizolo EA, Bostrom MP, et al. Intravenous vs oral acetaminophen as a component of multimodal analgesia after total hip arthroplasty: a randomized, blinded trial. The Journal of Arthroplasty. 2019; 34: S215–S220.

[11] Karam JA, Schwenk ES, Parvizi J. An update on multimodal pain management after total joint arthroplasty. Journal of Bone and Joint Surgery. 2021; 103: 1652–1662.

[12] Li WT, Bell KL, Yayac M, Barmann JA, Star AM, Austin MS. A postdischarge multimodal pain management cocktail following total knee arthroplasty reduces opioid consumption in the 30-day postoperative period: a group-randomized trial. The Journal of Arthroplasty. 2021; 36: 164–172.e2.

[13] Wang F, Ma WM, Huang ZH. Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement: a systematic review of the literature and meta-analysis of 5 randomized controlled trials. Medicine. 2021; 100: e25884.

[14] Gao C, Huang TT, Wu KR, Zhang W, Wang S, Chai XQ, et al. Multimodal analgesia for accelerated rehabilitation after total knee arthroplasty: a randomized, double-blind, controlled trial on the effect of the co-application of local infiltration analgesia and femoral nerve block combined with dexmedetomidine. Brain Sciences. 2022; 12: 1652.

[15] Urban JA, Dolesh K, Martin E. A multimodal pain management protocol including preoperative cryoneurolysis for total knee arthroplasty to reduce pain, opioid consumption, and length of stay. Arthroplasty Today. 2021; 10: 87–92.

[16] Takeda Y, Fukunishi S, Nishio S, Yoshiya S, Hashimoto K, Simura Y. Evaluating the effect of intravenous acetaminophen in multimodal analgesia after total hip arthroplasty: a randomized controlled trial. The Journal of Arthroplasty. 2019; 34: 1155–1161.

[17] Ochroch J, Qi V, Badiola I, Grosh T, Cai L, Graff V, et al. Analgesic efficacy of adding the IPACK block to a multimodal analgesia protocol for primary total knee arthroplasty. Regional Anesthesia & Pain Medicine. 2020; 45: 799–804.

[18] Muñoz-Leyva F, Jack JM, Bhatia A, Chin KJ, Gandhi R, Perlas A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesthesiology. 2022; 137: 459–470.

[19] Krishna Prasad GV. Post-operative analgesia techniques after total knee arthroplasty: a narrative review. Saudi Journal of Anaesthesia. 2020; 14: 85–90.

[20] Edwards RR, Campbell C, Schreiber KL, Meints S, Lazaridou A, Martel MO, et al. Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study. BMC Musculoskeletal Disorders. 2022; 23: 302.

[21] Luo Z, Li L, Wang D, Wang H, Pei F, Zhou Z. Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study. Journal of Orthopaedic Surgery and Research. 2019; 14: 378.

[22] Boye Larsen D, Laursen M, Simonsen O, Arendt-Nielsen L, Petersen KK. The association between sleep quality, preoperative risk factors for chronic postoperative pain and postoperative pain intensity 12 months after knee and hip arthroplasty. British Journal of Pain. 2021; 15: 486–496.

[23] Wang Y, Liu Y, Li X, LV Q, Xia Q, Wang X, et al. Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an enhanced recovery after surgery concept. Sleep and Breathing. 2021; 25: 1231–1237.

[24] Alipourian A, Farhadian N, Zereshki E, Khazaie H. Improvement of sleep quality 6 months after total knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2021; 16: 342.

[25] Bjurström MF, Irwin MR, Bodelsson M, Smith MT, Mattsson‐Carlgren N. Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty. European Journal of Pain. 2021; 25: 1482–1492.

[26] Pan X, Wang J, Lin Z, Dai W, Shi Z. Depression and anxiety are risk factors for postoperative pain-related symptoms and complications in patients undergoing primary total knee arthroplasty in the United States. The Journal of Arthroplasty. 2019; 34: 2337–2346.

[27] Putman S, Boureau F, Girard J, Migaud H, Pasquier G. Patellar complications after total knee arthroplasty. Orthopaedics & Traumatology: Surgery & Research. 2019; 105: S43–S51.

[28] Wainwright TW. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS®) society recommendations. Acta Orthopaedica. 2020; 91: 363.

[29] Yajnik M, Hill JN, Hunter OO, Howard SK, Kim TE, Harrison TK, et al. Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery. Patient Education and Counseling. 2019; 102: 383–387.


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