COMPARATIVE ANALYSIS OF FUNCTIONAL OUTCOME AND PAIN CONTROL USING NSAID VERSUS NON-NSAID MULTIMODAL ANALGESIC REGIMENS IN POSTOPERATIVE TOTAL KNEE ARTHROPLASTY

Abstract

Background: Effective postoperative pain management following total knee arthroplasty (TKA) is crucial for early mobilization, improved functional outcomes, and patient satisfaction. Multimodal analgesia is the standard of care, but the specific role and necessity of non-steroidal anti-inflammatory drugs (NSAIDs) within these protocols remain debated, particularly regarding the balance between analgesic efficacy and potential side effects.

Methods: This was a single-center, prospective, randomized, double-blind controlled trial. A total of 120 patients scheduled for unilateral TKA were randomized into two groups (n=60 per group). The NSAID group received a multimodal regimen including oral celecoxib, while the non-NSAID group received an identical regimen with a placebo. The primary outcomes were Visual Analog Scale (VAS) pain scores at 24, 48, and 72 hours, and total morphine milligram equivalent (MME) consumption in the first 72 hours. Secondary outcomes included Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee range of motion (ROM) at 6 weeks, as well as length of hospital stay and incidence of adverse events.

Results: The NSAID group reported significantly lower mean VAS pain scores with activity at 48 hours (3.8 ± 1.1 vs. 5.2 ± 1.4; p=0.002) and 72 hours (2.9 ± 0.9 vs. 4.1 ± 1.2; p<0.001). Total opioid consumption was significantly lower in the NSAID group (48.5 ± 15.2 MME) compared to the non-NSAID group (70.1 ± 22.5 MME; p<0.001). At the 6-week follow-up, the NSAID group demonstrated superior functional outcomes, with a higher mean KSS (85.2 ± 5.4 vs. 80.1 ± 6.9; p=0.003) and better active knee flexion (112.5° ± 8.1° vs. 106.3° ± 9.5°; p=0.002). There was no statistically significant difference in the incidence of nausea (16.7% vs. 11.7%; p=0.43) or acute kidney injury (1.7% vs. 0%; p=0.31).

Conclusion: The inclusion of a selective COX-2 inhibitor in a multimodal analgesic regimen for TKA significantly improves postoperative pain control, reduces opioid consumption, and leads to enhanced early functional recovery without a significant increase in short-term adverse events in a well-screened patient population.