Authors (including presenting author) :
Chen PY (1), Winnie Sammy (2), Aaron Ying (1)
Affiliation :
(1) Pain Management Division, Anaesthesia, PWH, (2) Anesthesia, The Chinese University of Hong Kong
Introduction :
Adequate pain relief is crucial to enhance functional restoration for patients underwent total knee replacement (TKR). However, IVPCA morphine with adjuvant oral tramadol and paracetamol as the mainstay analgesia regimen has been found inadequate. Furthermore, morphine and tramadol impose adverse effects such as nausea and vomiting. These undesirable outcomes refrain patients from using them thus jeopardizes their rehabilitation progress. Studies revealed that the use of preemptive analgesic before tissue injury may desensitize the peripheral and central nervous system and combining etoricoxib (COX-2), oxycodone (potent semisynthetic opioid) and paracetamol to address different pain mechanizms to achieve synergistic and opioid sparing effects.
Objectives :
This retrospective study analyzed data from patients undergone TKR surgery to determine the effectiveness of IVPCA versus POA on postoperative pain relief and any opioid-related side effects.
Methodology :
Among a total of 102 patients, 53 received both IVPCA and regular oral analgesics. Oxycontin was given upon cessation of IVPCA to enhance pain control and mobilization from September 2016 to February 2017, while 49 patients were given preemptive oral etoricoxib before surgery and duly together with oxycontin & paracetamol after surgery from September 2017 to February 2018.Pain scores on Day 4 as the primary outcome were measured by Numeric Rating Scale (0-10) at rest (NRS-R) and on movement (NRS-M). It was analyzed by one-way ANCOVA (analysis of covariance), and side effects (such as nausea) were analyzed by fisher’s exact test as secondary outcome.
Result & Outcome :
Demographic data of both groups were comparable. NRS-R of POA was significantly lower [mean (M)=0.37,standard error (SE)=0.16] when compared with the IVPCA group (M=0.87, SE=0.16) with a mean difference of 0.50, 95 CI [0.049,0.944], p=0.030, while NRS-M was also found significantly lower (M=2.96, SE=0.31) in POA group than the IVPCA group (M=4.26, SE=0.29) with a mean difference of 1.29, 95 CI [0.46, 2.13],p=0.003. A higher proportion of patients in the IVPCA group experienced at least one adverse effect than in the POA group (45% vs. 18%, fisher’s exact p=0.006).
Co-location with:
