[Application and effect of auricular acupoint pressing for analgesia in perioperative period of total knee joint replacement].
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Abstract:
To observe the effect of auricular acupoint pressing (AAP) for analgesia during perioperative period of total knee joint replacement.Sixty patients with osteoarthritis of ASA grade I - III scheduled to receive unilateral total knee joint replacement were equally randomized into the AAP group and the control group, 30 in each group. The general anesthesia on all patients was implemented by physicians of an identical group through endotracheal intubation. To the patients in the AAP group, AAP with Vaccaria seed was applied before operation, and the local analgesia on affected limb with acupoint pasting was used after operation. Besides, administering of celecoxib 400 mg on the day before operation, and celecoxib 200 mg twice daily post-operation was given to all patients. When the visual analogue scales (VAS) reached more than 7 points, 0.1 g of bucinnazine hydrochloride was given for supplement. Meantime, same post-operative training methods were adopted in both groups. The resting VAS pain scores, contentment of sedation, incidence of adverse event, postoperative range of motion (ROM) of knee joint and Hospital for Special Surgery (HSS) score were recorded.The resting VAS pain scores at 6 h and 24 h after operation was 5.99 +/- 0.67 scores and 4.26 +/- 0.59 scores in the AAP group respectively, which was significantly lower than that in the control group at the corresponding time (7.02 +/- 0.85 scores and 4.92 +/- 0.43 scores, P < 0.01); but it showed insignificant difference between the two groups at 1 h and 48 h after operation (P > 0.05); sedation contentment in the two groups was similar; incidence of adverse event in the AAP groups seemed lower (4 cases vs. 11 cases), but the intergroup difference was statistically insignificant (P > 0.05). ROM before surgery were 75.63 degrees +/- 5.74 degrees and 75.43 degrees +/- 5.63 degrees in the two groups respectively, showing no significant difference (P > 0.05), two weeks after operation, the initiative ROM raised to 96.50 degrees +/- 3.79 degrees and 93.50 degrees +/- 3.50 degrees, and the passive ROM reached 107.8 degrees +/- 3.37 degrees and 105.27 degrees +/- 3.25 degrees in the two groups respectively, with statistical significance between them (P < 0.05). HSS score was similar between groups before operation (60.23 +/- 3.44 scores vs. 61.70 +/- 2.83 scores, P > 0.05); while it became 86.97 +/- 2.33 scores and 85.37 +/- 2.30 scores after operation, showing significant difference between groups (P < 0.05).Applying auricular acupoint pressing in perioperative period of knee joint replacement is favorable for alleviating postoperative pain, decreasing narcotic consumption, and promoting early rehabilitation, and it has the advantages of low cost, less complication, simple manipulation and high safety.Keywords:
Celecoxib
Post-anesthesia care unit
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Objective To assess the effect of painless and the activity of knee joint postoperative through the use of patient-controlled epidural analgesia(PCEA) continues intra-articular and conventional of continuous epidural analgesia with epidural analgesia pump on postoperative pain after total knee arthroplasty(TKA).Methods From January 2010 to September,150 cases of patients with total knee replacement in People′s Hospital of Xinjiang Uygur Autonomous Region were randomly divided into 2 groups,each group had 65 cases.Patients in test group were taken patient-controlled epidural analgesia(PCEA) pumps at the knee joint cavity of continuous analgesia,control group were with routine epidural analgesia pump continuous epidural analgesia.Compared the two groups of patients with postoperative TKA 72 hours average resting after surgery pain in visual analogue scales(VAS) score record and postoperative(TKA) 1,2,3,7,40 day degree of motion in postoperative pain of VAS scores,activities of range of movement(ROM) and average score of KSS and overall satisfaction,in order to evluate the effects of two analgesia methods.Results In the postoperative TKA 72 h mean VAS score of resting pain after the surgery and postoperative pain VAS score of test group were significantly better than average movement control group,contrasted the activity of knee joint after knee surgery,the ROM and KSS average scores were significantly better than the control group(P0.05),but similar to the overall satisfaction of the two groups(P0.05).Conclusion With epidural analgesia pump knee joint cavity of continuous analgesia methods on total knee replacement in perioperative analgesic has significant,it can effectively control the pain after surgery to reduce adhesion of local soft tissue contracture,joint prevention activities limited,maximize activity of knee flexion,which was worth promoting.
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Objective
To compare the effect of continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) on pain relief, rehabilitation efficacy, satisfaction degree following total knee arthroplasty (TKA) in an attempt to find a safe and effective analgesia at the stage of rehabilitation.
Methods
The records of 116 patients undergone unilateral TKA for osteoarthritis or rheumatoid arthritis of the knee were evaluated. The patients with preoperative American Society of Anesthesiology (ASA) score of 1 to 3 were randomized into CFNB group (58 cases) and PCIA group(58 cases) according to the random number table. Both operations were performed under ultrasound guidance. Postoperative visual analogue score (VAS), knee function, incidence of adverse reaction, and satisfaction degree were compared between the two groups.
Results
Regardless of the score at postoperative 4 and 12 hours, VAS between CFNB and PCIA groups revealed significant differences at postoperative 24 [(3.2±1.1)points vs (4.1±1.5)points], 48 [(3.4±1.2)pointsvs (4.1±1.0) points] and 72 hours [(3.3±1.2)pointsvs (4.0±1.1)points] ( all P<0.05). Time to achieve knee rehabilitation training objectives like straight leg raise, walking with crutches, and passive bending to 90°were similar between the two groups. Both groups achieved comparable knee function status with respect to Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and maximal knee flexion angle at postoperative 3 months. Postoperative nausea and vomit were significantly more frequent in PCIA group (24%) than in CFNB group (14%) ( all P<0.05), but patients in both groups were satisfactory.
Conclusion
Ultrasound guided CFNB is an effective analgesic method during the early stage of TKA, for it can control pain, accelerate rehabilitation training and function recovery, reduce adverse reaction as well as improve patients' satisfaction.
Key words:
Arthroplasty, replacement, knee; Pain; Continuous femoral nerve block/patient controlled intravenous analgesia
Femoral nerve block
WOMAC
Oxford knee score
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To investigate the effect of adductor canal block combined with local infiltration anesthesia on the rehabilitation of primary total knee arthroplasty (TKA).A total of 104 patients who met the selection criteria for the first unilateral TKA between March 2017 and August 2017 were included in the study. They were randomly divided into trial group (53 cases) and control group (51 cases). In the trial group, the adductor canal block with intraoperative local infiltration anesthesia were performed. In the control group, only intraoperative local infil-tration anesthesia was performed. There was no significant difference in gender, age, body mass index, diagnosis, effected side, and the preoperative American Society of Anesthesiologists (ASA) grading between 2 groups ( P>0.05). The operation time, length of stay, and complications were compared between 2 groups, as well as visual analogue scale (VAS) score of incision at rest and during activity, the range of motion (ROM) of knee flexion and extension activity, limb swelling (thigh circumference), walking distance, and pain VAS score while walking.The operation time of the trial group was significantly shorter than that of the control group ( t=-2.861, P=0.005). However, there was no significant difference in length of stay between 2 groups ( t=-0.975, P=0.332). The wound effusion occurred in 1 patient of trial group and 2 of control group; hematoma occurred in 2 patients of trial group and 3 of control group; no symptom of intermuscular venous thrombosis occurred in 1 patient in each of 2 groups; ecchymosis occurred in 14 patients of trial group and 15 of control group; there was no significant difference in the incidence of related complications between 2 groups ( P>0.05). There was no significant difference in the preoperative VAS score at rest and during activity, ROM of knee flexion and extension activity, and thigh circumference between 2 groups ( P>0.05). However, there were significant differences in the VAS score at rest and during activity after 2, 4, 8, and 12 hours, ROM of knee flexion and extension activity after 1 and 2 days, and the walking distance on the day of discharge, pain VAS scores while walking after 1 and 2 days and on the day of discharge, and thigh circumference after 1 day between 2 groups ( P<0.05).For the primary TKA, the adductor canal block combined with local infiltration anesthesia can early relieve the initial pain of the incision, shorten the operation time, and promote the mobility and functional recovery of the knee joint.探讨收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术（total knee arthroplasty，TKA）后康复的影响。.将 2017 年 3 月—8 月拟行初次单侧 TKA 且符合选择标准的 104 例患者纳入研究，随机分为试验组（53 例）和对照组（51 例）。试验组行收肌管阻滞麻醉联合术中局部浸润麻醉镇痛，对照组仅行术中局部浸润麻醉镇痛。两组患者性别、年龄、体质量指数、病因、侧别、病程、术前美国麻醉医师学会（ASA）分级等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。比较两组手术时间、住院时间、并发症发生情况，以及术后静息状态及活动时膝关节切口疼痛视觉模拟评分（VAS）、膝关节屈伸活动度、肢体肿胀情况（大腿周径）、步行距离以及步行时切口疼痛 VAS 评分。.试验组手术时间较对照组明显缩短（ t=–2.861， P=0.005）；但两组住院时间比较差异无统计学意义（ t=–0.975， P=0.332）。术后试验组 1 例、对照组 2 例出现切口渗液，试验组 2 例、对照组 3 例出现血肿，两组各 1 例出现无症状性肌间静脉血栓，试验组 14 例、对照组 15 例出现瘀斑；两组以上并发症发生率比较差异均无统计学意义（ P>0.05）。两组术前静息状态及活动时膝关节 VAS 评分、膝关节屈伸活动度、大腿周径比较，差异均无统计学意义（ P<0.05）。但试验组术后 2、4、8、12 h 时静息状态及活动时 VAS 评分，术后 1、2 d 膝关节屈伸活动度，术后出院时步行距离，术后 1、2 d 及出院时步行疼痛 VAS 评分、术后 1 d 大腿周径均优于对照组，差异有统计学意义（ P<0.05）。.对于初次 TKA 患者，采用收肌管阻滞麻醉联合局部浸润麻醉镇痛能够减轻切口早期疼痛，有利于术后早期膝关节活动度和功能的康复。.
Adductor canal
Infiltration (HVAC)
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Objective To evaluate the effects of multimodal analgesia and patient control analgesia on the early rehabilitation of patients after total knee arthroplasty.Methods Eighty-four patients after total knee arthroplasty were randomly divided into two groups.Patient controlled analgesia and multimodal analgesia were provided for the patients in the control group and experimental group,respectively.All the patients performed postoperative functional exercises.The postoperative pain rated by visual analog scales (VAS) at different time-points,the completion of the rehabilitation plan,the function of the knee and patient satisfaction were compared between the two groups.Results The VAS scores for postoperative pain at rest at 2h,4h,6h,8h,10h,12h,18h,24h after the operation,and pain during passive activity at 24h,48h,72h after the operation were all significantly lower in experimental group than those of control group (P0.01).The range of motion of knee joint at 24h,48h,72h,1w,2w,4w after the operation was higher in the experimental group than those of control group(P0.01).The completion of the rehabilitation plan was better and patient satisfaction was higher in the experimental group than that of control group (P0.05).Conclusion The multimodal analgesia is more effective than routine analgesia method in the control of postoperative pain after total knee arthroplasty.Moreover,it can promote the completion of postoperative rehabilitation plan.
Pain control
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[Objective] To observe the effect of auricular acupuncture combined with convalescence on patients after total knee replacement or total knee arthroplasty(TKA).[Methods] The 60 patients were divided into treatment group treated with auricular acupuncture combined with convalescence and control group treated with CPM only for 3 weeks.The effect,including knee active range of motion(AROM),WOMAC score and FIM score,in two groups was evaluated,compared and statistically analyzed.[Results] There was significant difference between the two groups in AROM,WOMAC score and FIM score.AROM of patients in treatment group was larger than those of patients in control group(P0.01).WOMAC score of treatment group was lower than control group(P0.05,P0.01),and FIM score in treatment group was better than control group(P0.05).[Conclusion] Auricular acupuncture combined with convalescence has good effect on patients with TKA.
Convalescence
WOMAC
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Knee osteoarthritis is a major cause of knee pain. Conservative therapy resources are limited due to adverse effects. Therefore, alternative non-invasive therapy approaches to reduce pain medications are gaining importance. The current study analyses if electrical auricular acupuncture (EAA) or low frequency modulated electric current therapy (LFMECT) could support analgesic treatment.In a randomized pilot trial patients with painful knee OA were treated with EAA (group 1) or LFMECT (group 2) additional to standard pharmacological analgesic treatment. In total 19 female and 10 male patients with a mean age of 59.1 years (standard deviation ± 13.6) and a mean BMI of 28.9 kg/m2 (± 5.2) were included. Patients were randomly assigned to one of the groups stratified for age, gender and BMI. Before starting of the active study period and collecting of the initial data on day 1, all patients received a pharmacological analgesic baseline therapy for one week. At the next study stage patients started their randomly assigned treatment protocol for 42 days and final follow-up was set on day 70. Patients recorded their pain intensity (numerical rating scale; NRS) using a standardized patient diary. The pain free walking time in min was recorded and range of motion was assessed.Rescue medication intake was comparable between both groups on day 42 (p = 0.55) and day 70 (p = 0.35). After the active study period (day 42) pain scores decreased significantly in both groups (group 1 p = 0.02; group 2 p = 0.0006). At follow up median pain scores further decreased in group 1 (p = 0.0002) and remained at a low level in group 2 (p = 0.001). Level of pain decreased in about 50% in both groups and was comparable during the study period. Total mean range of motion (ROM) increased in both groups (group 1 p = 0.0003; group 2 p = 0.02). Group 1 had more improvement of mean total ROM compared to group 2 (p = 0.034). Pain-free walking time increased in both groups and was comparable between both groups (p = 0.31). Any adverse effects due to EAA or LFMECT were not observed.Data of the current study indicates that implementation of EAA or LFMECT seems to be beneficial to reduce knee pain and improve knee function in patients with knee osteoarthritis.
Electrical current
Acupuncture therapy
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Objective To investigate the combined effect of auricular point and wrist needle on pain of patients after hip replacement. Methods The 70 patients in our hospital with hip replacement surgery were divided into the treatment group and control group randomly,each with 35 cases. The control group received the conventional nursing intervention,and the treatment group was treated with auricular point and wrist ankle needle invention on the basis of the control group. The degree of pain,adverse reactions,patients' satisfaction and recovery of hip function between the two groups were compared. Results The VAS scores in the treatment group on 2,6,12,24,48,72 h and 7 d were significantly lower than those in the control group,the differences were statistically significant( P 0. 05). The incidence of adverse reactions in treatment group was significantly lower than that in control group,the difference was statistically significant( P 0. 05). The Harris hip function scores in the treatment group after 14 d was significantly higher than that in control group,the difference was statistically significant( P 0. 05). Conclusion Combined use of auricular point and wrist needle on pain of patients after hip replacement can effectively reduce the pain,help restore joint function and reduce the incidence of adverse reactions.
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To observe the effect of intradermal needing combined with rehabilitation intervention on middle and early knee osteoarthritis.Seventy patients were randomly divided into an observation group and a control group, 35 cases in each group. Excluding the dropping cases, finally, 34 cases in the observation group and 32 cases in the control group were included in the statistics. Intradermal needing combined with rehabilitation intervention were given in the observation group, the intradermal needing was applied at Dubi (ST 35), Neixiyan (EX-LE 8), Xuehai (SP 10), Liangqiu (ST 34), Yanglingquan (GB 34), ashi point, and retained for 24 h; the simple conventional rehabilitation intervention was given in the control group. The visual analogue scale (VAS) was used to evaluate knee pain before treatment, the end of initial treatment, 1 month after treatment, and 3 months after treatment. The Western Ontario and McMaster Osteoarthritis index (WOMAC) was used to assess the joint function of the knee, the active knee flexion range (ROM) was used to assess the joint mobility of the knee before treatment and 1 month after treatment, and the efficacy of the two groups was evaluated.At the end of the initial treatment, the VAS score in the observation group were significantly improved as compared with that before treatment and the control groups (P<0.05), but there was no significant difference in the control group compared with that before treatment (P>0.05). After 1 month of treatment, the VAS score, WOMAC score and ROM measurement in the two groups were significantly improved as compared with those before treatment (P<0.05), and the observation group was superior to the control group (P<0.05); the total effective rate in the observation group was 97.1% (33/34), which was better than 81.3% (26/32) in the control group (P<0.05). At the follow-up, the VAS scores in the two groups were slightly higher than those after 1 month of treatment, but the difference was still statistically significant as compared with those before treatment (P<0.05), and the observation group was still superior to the control group (P<0.05).The combination of intradermal needing combined with rehabilitation intervention can effectively alleviate knee pain and improve joint function. It has a beneficial effect on the rehabilitation of middle and early knee osteoarthritis.
WOMAC
Dry Needling
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Objective To explore the effect of knee joint function exercise on knee rehabilitation after operation under the long-term epidural analgesia. Methods One hundred postoperative patients with fractures around the knee were randomly divided into two groups. Fifty patients in traditional group were treated by epidural analgesia in first two days and then given oral painkiller in the next eight days. Fifty patients in observation group were treated by epidural analgesia in ten days with subcutaneous implantation of epidural catheter. All patients in two groups were treated by the same functional exercise. The VAS and Bromage score,the incidence of asking for the extra pain medicine,the passive range of motion( PROM) and autonomic range of motion( AROM) of affected limb,the ratios of AROM up to 90°,110°,130° at the different time were observed and recorded.,and the rehabilitation effect of knee joint functional were compared between two groups. Results The scores of VAS had no significant difference between two groups at 1 d after surgery, but the VAS scores were significantly lower in observation group than in traditional group at 3,4,6,8,10 d after operation( P 0. 01). No obvious motor block was found in two groups. The incidence of asking for the extra pain medicine was significantly lower in observation group than in traditional group. PROM and AROM in observation group were significantly higher than those in traditional group at 6,8,10,15,30 d after operation( P 0. 05 or P 0. 01). The ratios of AROM up to 90°,110°,130° were significantly higher in observation group than in traditional group at 8,10,15,30 d after operation( P 0. 05 or P 0. 01). Conclusion Improved epidural analgesia could extend the time of function exercise to improve the effect,speed up the recovery process,and effectively prevent the stiffness of knee joint.
Prom
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To investigate the effect of acupuncture and moxibustion on functional recovery after knee arthroplasty. One hundred cases of knee arthroplasty were performed in the PLA's 371th Hospital of the PLA from February 1, 2017 to March 22, 2018. Random divided into observation group and control group, each group of 50 cases, observation group on the basis of postoperative routine nursing acupuncture treatment; In the control group of 50 patients, routine postoperative care was given to evaluate the knee function of the two groups of patients and the values of aLDFA and aMFTA in the direction of the distal femoral axis. HSS knee function score was significantly improved in two groups (P<0.05), The HSS knee function score was better than that of the control group (P<0.05). The observation group aLDFA and aMFTA were superior to the control group (P<0.05). The difference is statistically significant. Acupuncture and moxibustion can promote the recovery of knee joint after replacement, which is beneficial to the rehabilitation of patients.
Moxibustion
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