Authors (including presenting author) :
ChanTHM(1), ChanCWT (1)(2)
Affiliation :
(1)Department of Anaesthesiology, Queen Mary Hospital
Introduction :
Total joint arthroplasty (TJA) is a common orthopedic procedure to treat patients with end-stage knee arthritis. Over 4,000 TJA were performed in the Hong Kong public hospitals in the past 12 months (July 2020 – June 2021) and the demand for this procedure is ever increasing with time1.
Objectives :
TJA are rehabilitative surgeries with an aim to accelerate patient ambulation and minimize hospital stay. To facilitate this process, multi-disciplinary enhanced recovery after surgery (ERAS) programs are implemented. This involves surgeons, anaesthetists, physiotherapists and nurses who follow an integrated care pathway to allow early patient mobilization and hospital discharge. The program reduces the hospital length of stay and this can reduce the risk of complications and mortality2. One of the major challenges in TJA is postoperative pain. TJA is a very painful procedure with up to 50% of patients have moderate to severe pain (numeric rating scale >4) immediately after surgery3. This can delay patient mobilization and hinder postoperative recovery. Severe postoperative pain is also associated with an increased risk of infection, myocardial ischaemia, respiratory complications and the development of chronic pain4. Therefore, an effective multimodal analgesia is an essential component in the ERAS program. It combines different oral analgesics to limit opioid use and its related side effects. Celecoxib has been shown to reduce pain and opioid use after TJA. It is therefore recommended to be used routinely5. However, its potential nephrotoxic property has led to its judicious use, especially in patients with preoperative chronic renal failure. Postoperative acute kidney injury (AKI) is an independent risk factor for mortality, cardiovascular complications and hospital length of stay6. However, the studies assessing the incidence of AKI following TJA are scarce, and with conflicting results. Therefore, the aim of our study is to retrospectively review the incidence and duration of AKI following elective TJA in a tertiary institution. We will evaluate the effect of celecoxib in our multimodal analgesia regimen on the risk of postoperative AKI and determine the risk factors associated.
Methodology :
Patients and study design We will perform a retrospective review of xxxx patients in our database who underwent elective primary and revision TJA in Queen Mary Hospital, Hong Kong from from January to December 202x. Relevant data were retrieved from the computerised medical records system. Patients with rheumatoid arthritis were excluded, leaving xxx patients for analysis. The patients who performed TJA surgeries were routinely assessed in a preoperative assessment clinic by anesthetists. After evaluation, they would be enrolled into an ERAS protocol and a multimodal analgesia regime would be started. If the patient’s preoperative renal function was adequate (Serum Creatinine < 200μmol/L), Celecoxib (200mg BD) would be given preoperatively and for 5 days postoperatively.
Result & Outcome :
Other oral analgesics included paracetamol, pregabalin and oxycodone. Periarticular infiltration of different regimens of cocktail (ropivacaine, hydrocortisone with ketorolac) were also given intraoperatively for total knee arthroplasty.
