Preemptive Analgesia for Pain Management in Total Knee Arthroplasty: An Asian Perspective

Background: Knee osteoarthritis is a debilitating condition affecting up to 11% of individuals in Singapore. Total knee arthroplasty (TKA) is one of the most effective treatments for this condition. However, it is also associated with significant post-operative pain that can limit post-operative rehabilitation and outcomes. Preemptive analgesia (PA) is a proactive approach to pain management and has shown promising outcomes. Objective: To study the short-term outcomes of preemptive analgesia in patients undergoing TKA. Method: A retrospective review of a database from January 2022 to December 2022 identified all TKA cases performed by one senior orthopaedic surgeon. Eligible patients were divided into those who received PA and those who did not receive PA. The PA group received oral medications consisting of 50 mg tramadol, 200 mg celecoxib, 1000 mg paracetamol, and 300 mg gabapentin one hour before surgery. No preoperative analgesia was given in the non-PA group. Outcome assessments included VAS scores at 6 and 24 hours postoperatively, degree of active range of motion (ROM) of the knee and the ability to perform a straight leg raise (SLR) 24 hours after surgery, requirement of breakthrough analgesia and length of stay (LOS) in the hospital. Results: 104 patients were identified, with 53 patients in the PA group and 51 patients in the non-PA group. The PA group had lower VAS scores at 6 hours (1.94 vs. 2.24), but higher VAS scores at 24 hours compared to the non-PA group (3.75 vs. 3.43). Differences in VAS scores were not statistically significant. The ROM and SLR were similar between the PA and the non-PA group (83.4° vs. 81.3°, P = 0.44) and (77.4% vs. 68.6%, P = 0.25). There was no significant difference in requirements of breakthrough analgesia between both groups. LOS was comparable between both groups as well. Conclusion: The use of preemptive analgesia with a combination of tramadol, celecoxib, paracetamol, and gabapentin did not significantly reduce postoperative pain after TKA.