Slovenská chirurgia 3 - 4/2021
Importance of complex analgetic therapy in arthroplasty of the knee
Arthroplasty of large joints are ranked among the most common surgical procedures in orthopaedics. With the rise of average lifetime, the number of patients inicated for an implantation of an endoprosthesis is also rising. A significant rise is spotted mainly in the arthroplasty of the knee joint. The adequate management of pain in peri- and post- operation period is crucial in an effort to secure an early post-operation rehabilitation, adequate length of hospitalization and satisfaction of patients. Immense post-operation pain not only causes the suffering of patient but also has a complex negative effect on patient’s post-operation recovery. In recent years, commonly used methods are changing into newer and different methods. The objective is to reach a quality of analgetic treatment which fulfills the requirements expected from it. That meaning the analgetical treatment will be safe, effective, simple, global and cheap. In the present, there aren’t clear conclusions and scientificaly confirmed reccomendations in area of these trends but it seems as so the basic trends are a step forward in the multimodal approach and an establishment of a preemptive approach with the reduction of usage of opiates and rather using different medicaments in combinations, which can be also dosed orally. The mainly used pharmaceuticals are in the group of selective COX-2 inhibitors, mostly celecoxib in combination with gabapentin (or pregabalin) and acetaminofen. In the present, there are also informations about the positive influence of corticoids as a part of analgetical multimodal treatment. Exact dosing, length of administration resp. combinations with the utilisation of neuraxial anesthesia is still a matter of researches. In our study, we focus on significantly outstanding effect of our combination of pharmaceuticals in early post-operation period.
Keywords: total knee arthroplasty, analgesic management, postoperative pain, pain management
