The effects of patient-controlled epidural analgesia on early rehabilitation programmes following total knee replacement surgery: a retrospective cross-sectional study

Background/Aims Total knee replacement is a surgical procedure used to restore function and reduce pain in patients with severe knee osteoarthritis. Effective pain management can prevent complications, such as deep vein thrombosis, enables faster recovery, reduces hospital stays and improves functional outcomes. Research has found that during the 48 hours following surgery, patient-controlled epidural analgesia provided superior analgesia compared to other conventional analgesic methods. However, its impact on early rehabilitation after total knee replacement remains understudied as regards the efficacy and safety. The aim of this retrospective cross-sectional study was to evaluate the impact of patient-controlled epidural analgesia on early rehabilitation programmes following total knee replacement surgery, while also investigating the influence of other factors that may affect early mobilisation after surgery. Methods A retrospective cross-sectional study was conducted to review the data of patients who received patient-controlled epidural analgesia for pain following elective unilateral total knee replacement surgery between January 2017 and August 2022, who were referred to rehabilitation in the Security Forces Hospital in Makkah, Saudi Arabia. Two groups of patients were analysed, those who started mobilising on the first day and those who started mobilising on the second day following surgery. Results A total of 186 patients were included in this study with a mean age at admission of 68.12 ± 7.59 years. Most patients (84.4%) started mobilising on the first day after surgery and (15.6%) started on the second day. When comparing mobilised patients on the first and second days, there was a statistically significant difference (P≤0.05), between the groups in terms of dizziness and hypotension. However, there were no statistically significant relationships between ambulation start and patient-controlled epidural analgesia method, dose, kind of adjunct pain medication or Bromage Score. There was no significant difference in pain scores between the two groups on the first day following surgery (P>0.05). Patients who mobilised on the first day demonstrated significantly higher levels of independence in their daily activities, as measured by the Elderly Mobility Scale and Barthel Index (P≤0.05). Conclusions Patient-controlled epidural analgesia within a multimodal pain management plan following total knee replacement surgery does not adversely affect early rehabilitation and can contribute to the successful attainment of functional independence. Implications for practice The use of patient-controlled epidural analgesia provides effective analgesia in the postoperative period after total knee replacement surgery and is associated with few serious complications and facilitated early rehabilitation.