THE EFFECT OF BALANCED ANALGESIA ON EARLY CONVALESCENCE AFTER MAJOR ORTHOPEDIC-SURGERY

Forty-two patients scheduled for total knee arthroplasty (n = 20) or h ip arthroplasty (n = 22) were randomly allocated to receive either con tinuous epidural bupivacaine/morphine for 48 h postoperatively plus or al piroxicam, or general anaesthesia followed by a conventional intram uscular opioid and acetaminophen regimen. Patients undergoing knee- or hip arthroplasty treated with epidural analgesia had significantly lo wer pain scores during mobilization under the 48 h epidural infusion c ompared with patients receiving conventional treatment, while no impor tant differences were observed after cessation of the epidural regimen . However, the achieved pain relief had no impact on postoperative con valescence parameters, such as ambulation, patient activity including need for nursing care, fatigue or hospital stay. Late postoperative pa in, fatigue and conservative attitudes and routines in the postoperati ve care, were the most important reasons limiting mobilization and act ivity. We conclude that effective early (48 h) postoperative pain reli ef with balanced analgesia does not per se lead to important improveme nts in convalescence and hospital stay.