Evaluation of the effectiveness of the analgesic effect of selective and non-selective cyclooxygenase blockers in the composition of multimodal analgesia after knee joint endoprosthesis replacement

The purpose of the work is to compare the effectiveness of anesthesia with the use of a highly specific blocker COX-2 and a dedicated cyclo-oxygenase blocker COX-1 and COX-2 lornoxicam as part of multimodal analgesia in patients after primary knee replacement. The material was the cases of knee prosthesis (N=196) using multimodal analgesia; patients were divided into two groups, depending on the type of anesthesia, in accordance with the developed scheme of pharmacotherapy: I - receiving celecoxib (n=98) and II - lornoxicam (n=98). Methods for evaluating the effectiveness of anesthesia were the visual analogue scale (VAS), the KSS knee joint function evaluation scale before surgery and on the 5th day after it; analysis of the features of early verticalization, the patient's need for additional pain relief after surgery; costs of drug therapy are calculated. Results. Patients of both groups were comparable in age and average duration of hospitalization. The pain syndrome assessment on the VAS scale showed a higher efficacy of pain relief on days 1 and 5 in group II (4.1 ± 0.1 versus 3.5 ± 0.1 and 1.9 ± 0.04 versus 1.6 ± 0.1 points respectively) (p<0.05). Evaluation of the functional activity of the prosthetic knee joint on the KSS scale did not reveal any differences between the groups. Of the features of early verticalization on the first day after surgery, a higher percentage of weakness in the legs (79.6%) and nausea (70.4%) was noted in group I, and a higher percentage of dizziness (15.3%) and hemodynamic disorders ( 6.1% of cases). The cost of providing basic pain therapy in group I was 2.4 times higher than in group II, with the same costs for additional anesthesia with solutions of paracetamol and narcotic analgesics. Conclusions. As part of multimodal analgesia, Lornoxicam showed a higher efficacy in relieving pain syndrome at a low cost of a course of treatment compared with celecoxib.

эндопротезирование коленного сустава, обезболивание, целекоксиб, лорноксикам, knee arthroplasty, analgesia, celecoxib, lornoxicam

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