EFFICACY OF SEQUENTIAL TREATMENT WITH ADDUCTOR CANAL NERVE BLOCK AND CYCLOOXYGENASE 2 SELECTIVE INHIBITOR AFTER TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGTimin ¹ , SIHaibo ¹ , WUYuangang ¹ , ZENGYi ¹ , PEIFuxing ¹ ,  WENGXisheng ² ,  SHENBin ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopaedics, Peking Union Medical College Hospital;

Corresponding author：

WENGXisheng, Email: XSHWENG@medmail.com.cn; SHENBin, Email: shenbin_1971@163.com

Keywords：

Total knee arthroplasty; Adductor canal nerve block; Cyclooxygenase 2 selective inhibitor; Pain relief

DOI：

10.7507/1002-1892.20160217

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Objective To investigate the efficacy of sequential treatment with adductor canal nerve block (ACNB) and cyclooxygenase 2 (COX-2) selective inhibitor (parecoxib and celecoxib) after primary total knee arthroplasty (TKA). Methods Between January 2015 and December 2015, 90 osteoarthritis patients who met the inclusion criteria were treated, and randomly divided into 3 groups:ACNB+COX-2 group (group A, n=30), COX-2 group (group B, n=30), and control group (group C, n=30). There was no significant difference in gender, age, body mass index, side, and osteoarthritis duration between groups (P > 0.05), and the data were comparable. ACNB was used in group A at the end of TKA. Intravenous injection of parecoxib (40 mg per 12 hours) was administrated at the first three postoperative days, and followed by oral celecoxib (200 mg per 12 hours) until 6 weeks after operation in groups A and B; while placebo was given at the same time point in group C. Oral tramadol or intravenous morphine, as remedial measures, were introduced when patients had a visual analogue scale (VAS) score more than 4. The following indicators were compared between groups:the operative time, drainage volume at 24 hours after operation, length of hospital stay, and incidence of side effect; VAS pain scores, morphine consumption, range of motion (ROM) of the knee joint, and inflammatory cytokines levels at pre-operation and at 1 day, 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation; morphine consumption within first 24 hours and at 24 hours to 6 weeks after operation; the American Hospital for Special Surgery (HSS) score at 1, 2, 4, and 6 weeks after operation; and the serum coagulation parameters at pre-operation, and at 1, 3, and 14 days after operation. Results The length of hospital stay was significantly shorter and the incidence of postoperative nausea and vomiting was significantly lower in groups A and B than group C (P < 0.05). The VAS scores at rest (VASR) of groups A and B were significantly lower than that of group C at 1, 2, and 3 days after operation (P < 0.05); difference in the VAS scores at walking (VASW) was significant between groups at 1 day after operation (P < 0.05), and group A had the lowest VASW; and the VASW of groups A and B were significantly lower than that of group C at 2 and 3 days and at 1, 2, 4, and 6 weeks after operation (P < 0.05). The difference in morphine consumption was significant between groups within the first 24 hours after operation (P < 0.05), and group A exhibited the lowest consumption; and the morphine consumption in groups A and B was significantly lower than that in group C at 24 hours to 6 weeks after operation (P < 0.05). Significant difference was found in HSS scores between groups at 1, 2, 4, and 6 weeks after operation, and group A showed the highest score (P < 0.05). At 1 and 2 days after operation, group A showed the highest ROM (P < 0.05), and ROM of groups A and B was significantly higher that of group C at 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation (P < 0.05). Groups A and B were significantly lower than group C in the serum erythrocyte sedimentation rate at 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks, in C-reactive protein levels at 1, 2, and 3 days, in interleukin 6 (IL-6) and TNF-α levels at 1 day to 6 weeks, and in IL-8 level at 2 and 3 days (P < 0.05). The drainage volume within the first 24 hours and the serum coagulation parameters within the 2 weeks after operation showed no significant difference between groups (P > 0.05). Conclusion Sequential treatment with ACNB and COX-2 selective inhibitor is a safe and effective approach for postoperative pain management after primary TKA, and it can alleviate postoperative pain, promote the joint function recovery, and reduce the risk of adverse reactions.

Citation： YANGTimin, SIHaibo, WUYuangang, ZENGYi, PEIFuxing, WENGXisheng, SHENBin. EFFICACY OF SEQUENTIAL TREATMENT WITH ADDUCTOR CANAL NERVE BLOCK AND CYCLOOXYGENASE 2 SELECTIVE INHIBITOR AFTER TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1065-1071. doi: 10.7507/1002-1892.20160217 Copy

1.	Scott WW, Levy M, Rickert KL, et al. Assessment of common nonsteroidal anti-inflammatory medications by whole blood aggregometry:a clinical evaluation for the perioperative setting. World Neurosurg, 2014, 82(5):e633-638.
2.	Robinson CM, Christie J, Malcolm-Smith N. Nonsteroidal anti-inflammatory drugs, perioperative blood loss, and transfusion requirements in elective hip arthroplasty. J Arthroplasty, 1993, 8(6):607-610.
3.	Lin J, Zhang L, Yang H. Perioperative administration of selective cyclooxygenase-2 inhibitors for postoperative pain management in patients after total knee arthroplasty. J Arthroplasty, 2013, 28(2):207-213.e202.
4.	Ittichaikulthol W, Prachanpanich N, Kositchaiwat C, et al. The post-operative analgesic efficacy of celecoxib compared with placebo and parecoxib after total hip or knee arthroplasty. J Med Assoc Thai, 2010, 93(8):937-942.
5.	Sawhney M, Mehdian H, Kashin B, et al. Pain after unilateral total knee arthroplasty:a prospective randomized controlled trial examining the analgesic effectiveness of a combined adductor canal peripheral nerve block with periarticular infiltration versus adductor canal nerve block alone versus periarticular infiltration alone. Anesth Analg, 2016, 122(6):2040-2046.
6.	Lovecchio F, Alvi H, Sahota S, et al. Is outpatient arthroplasty as safe as fast-track inpatient arthroplasty? A propensity score matched analysis. J Arthroplasty, 2016.[Epub ahead of print].
7.	Di Lorenzo L, Foti C, Forte AM, et al. The addition of tramadol as a second opioid may improve pain relief in severe osteoarthritis:a prospective study. Pain Pract, 2010, 10(6):540-547.
8.	Bozimowski G. A review of nonsteroidal anti-inflammatory drugs. AANA J, 2015, 83(6):425-433.
9.	王海兴, 林子洪, 陈桂浩, 等.塞来昔布对全髋关节置换患者术前疼痛影响的随机双盲对照研究.中国矫形外科杂志, 2014, 22(4):315-319.
10.	Kazerooni R, Tran MH. Evaluation of celecoxib addition to pain protocol after total hip and knee arthroplasty stratified by opioid tolerance. Clin J Pain, 2015, 31(10):903-908.
11.	Smith EB, Shafi KA, Greis AC, et al. Decreased flexion contracture after total knee arthroplasty using Botulinum toxin A:a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2016.[Epub ahead of print].
12.	Narita M, Shimamura M, Imai S, et al. Role of interleukin-1beta and tumor necrosis factor-alpha-dependent expression of cyclooxygenase-2 mRNA in thermal hyperalgesia induced by chronic inflammation in mice. Neuroscience, 2008, 152(2):477-486.
13.	Wasko MK, Bobecka-Wesolowska K, Tomasiuk R, et al. Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty. Clin Chem Lab Med, 2015, 53(11):1785-1792.
14.	Honsawek S, Deepaisarnsakul B, Tanavalee A, et al. Relationship of serum IL-6, C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty:a prospective study. Int Orthop, 2011, 35(1):31-35.
15.	Miller RE, Miller RJ, Malfait AM. Osteoarthritis joint pain:the cytokine connection. Cytokine, 2014, 70(2):185-193.
16.	Prudy M, Kokki M, Anttila M, et al. Does the rectus sheath block analgesia reduce the inflammatory response biomarkers' IL-1ra, IL-6, IL-8, IL-10 and IL-1β concentrations following surgery? A randomized clinical trial of patients with cancer and benign disease. Anticancer Res, 2016, 36(6):3005-3011.
17.	Thomas T, Robinson C, Champion D, et al. Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain, 1998, 75(2-3):177-185.
18.	Reuben SS, Buvenandran A, Katz B, et al. A prospective randomized trial on the role of perioperative celecoxib administration for total knee arthroplasty:improving clinical outcomes. Anesth Analg, 2008, 106(4):1258-1264.

1. Scott WW, Levy M, Rickert KL, et al. Assessment of common nonsteroidal anti-inflammatory medications by whole blood aggregometry:a clinical evaluation for the perioperative setting. World Neurosurg, 2014, 82(5):e633-638.
2. Robinson CM, Christie J, Malcolm-Smith N. Nonsteroidal anti-inflammatory drugs, perioperative blood loss, and transfusion requirements in elective hip arthroplasty. J Arthroplasty, 1993, 8(6):607-610.
3. Lin J, Zhang L, Yang H. Perioperative administration of selective cyclooxygenase-2 inhibitors for postoperative pain management in patients after total knee arthroplasty. J Arthroplasty, 2013, 28(2):207-213.e202.
4. Ittichaikulthol W, Prachanpanich N, Kositchaiwat C, et al. The post-operative analgesic efficacy of celecoxib compared with placebo and parecoxib after total hip or knee arthroplasty. J Med Assoc Thai, 2010, 93(8):937-942.
5. Sawhney M, Mehdian H, Kashin B, et al. Pain after unilateral total knee arthroplasty:a prospective randomized controlled trial examining the analgesic effectiveness of a combined adductor canal peripheral nerve block with periarticular infiltration versus adductor canal nerve block alone versus periarticular infiltration alone. Anesth Analg, 2016, 122(6):2040-2046.
6. Lovecchio F, Alvi H, Sahota S, et al. Is outpatient arthroplasty as safe as fast-track inpatient arthroplasty? A propensity score matched analysis. J Arthroplasty, 2016.[Epub ahead of print].
7. Di Lorenzo L, Foti C, Forte AM, et al. The addition of tramadol as a second opioid may improve pain relief in severe osteoarthritis:a prospective study. Pain Pract, 2010, 10(6):540-547.
8. Bozimowski G. A review of nonsteroidal anti-inflammatory drugs. AANA J, 2015, 83(6):425-433.
9. 王海兴, 林子洪, 陈桂浩, 等.塞来昔布对全髋关节置换患者术前疼痛影响的随机双盲对照研究.中国矫形外科杂志, 2014, 22(4):315-319.
10. Kazerooni R, Tran MH. Evaluation of celecoxib addition to pain protocol after total hip and knee arthroplasty stratified by opioid tolerance. Clin J Pain, 2015, 31(10):903-908.
11. Smith EB, Shafi KA, Greis AC, et al. Decreased flexion contracture after total knee arthroplasty using Botulinum toxin A:a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2016.[Epub ahead of print].
12. Narita M, Shimamura M, Imai S, et al. Role of interleukin-1beta and tumor necrosis factor-alpha-dependent expression of cyclooxygenase-2 mRNA in thermal hyperalgesia induced by chronic inflammation in mice. Neuroscience, 2008, 152(2):477-486.
13. Wasko MK, Bobecka-Wesolowska K, Tomasiuk R, et al. Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty. Clin Chem Lab Med, 2015, 53(11):1785-1792.
14. Honsawek S, Deepaisarnsakul B, Tanavalee A, et al. Relationship of serum IL-6, C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty:a prospective study. Int Orthop, 2011, 35(1):31-35.
15. Miller RE, Miller RJ, Malfait AM. Osteoarthritis joint pain:the cytokine connection. Cytokine, 2014, 70(2):185-193.
16. Prudy M, Kokki M, Anttila M, et al. Does the rectus sheath block analgesia reduce the inflammatory response biomarkers' IL-1ra, IL-6, IL-8, IL-10 and IL-1β concentrations following surgery? A randomized clinical trial of patients with cancer and benign disease. Anticancer Res, 2016, 36(6):3005-3011.
17. Thomas T, Robinson C, Champion D, et al. Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain, 1998, 75(2-3):177-185.
18. Reuben SS, Buvenandran A, Katz B, et al. A prospective randomized trial on the role of perioperative celecoxib administration for total knee arthroplasty:improving clinical outcomes. Anesth Analg, 2008, 106(4):1258-1264.

Chinese Journal of Reparative and Reconstructive Surgery

EFFICACY OF SEQUENTIAL TREATMENT WITH ADDUCTOR CANAL NERVE BLOCK AND CYCLOOXYGENASE 2 SELECTIVE INHIBITOR AFTER TOTAL KNEE ARTHROPLASTY

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