Comparing Apotel and Remifentanil for Multimodal Patient-Controlled Analgesia in Postoperative Pain Management Following Total Knee Arthroplasty Surgery: A Randomized Controlled Trial

Seyed Ali Golrokh Moghadam; Amin Tajerian; Behnam Mahmoudieh; Mohsen Parsi Khamene; Alireza Kamali

doi:10.5812/aapm-141975

Comparing Apotel and Remifentanil for Multimodal Patient-Controlled Analgesia in Postoperative Pain Management Following Total Knee Arthroplasty Surgery: A Randomized Controlled Trial

Anesth Pain Med. 2024 Mar 18;14(2):e141975. doi: 10.5812/aapm-141975. eCollection 2024 Apr.

Authors

Seyed Ali Golrokh Moghadam¹, Amin Tajerian¹, Behnam Mahmoudieh², Mohsen Parsi Khamene³, Alireza Kamali²

Affiliations

¹ School of Medicine, Arak University of Medical Sciences, Arak, Iran.
² Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.
³ Department of Orthopedic Surgery, Arak University of Medical Sciences, Arak, Iran.

Abstract

Background: Total knee arthroplasty (TKA) is a standard surgical procedure for individuals with debilitating knee arthritis. Effective postoperative pain management is essential for successful recovery, although traditional opioid-based methods have limitations.

Objectives: This study aimed to compare the efficacy of Apotel and remifentanil patient-controlled analgesia in managing postoperative pain after TKA.

Methods: This double-blind, randomized, controlled clinical trial took place at Amir-al-Momenin and Qods Hospitals in Arak, Iran, spanning from June 2022 to September 2023. Sixty-two eligible patients scheduled for knee joint replacement were randomly assigned to receive either Apotel (Group A) or remifentanil (Group R) as part of multimodal analgesia administered via a pain pump for postoperative pain relief in TKA. The study assessed hemodynamic parameters, pain levels (measured using the Visual Analog Scale), analgesic duration, and narcotic consumption. Statistical analyses were performed using SPSS v.27 and Plotly.

Results: Subjects exhibited no statistically significant differences in age, gender distribution, duration of surgery, or anesthesia. The hemodynamic status assessment in the recovery room showed no significant differences in SPO₂, PR, or MAP between the groups. However, remifentanil demonstrated superior effectiveness in reducing pain over 24 hours post TKA surgery compared to Apotel, as evidenced by lower average Visual Analog Scale (VAS) scores (P < 0.001), longer duration without the need for narcotic painkillers (P < 0.001), and lower cumulative opioid analgesic consumption in Group R (P < 0.001).

Conclusions: Remifentanil demonstrates superior pain control in a multimodal pain management approach compared to Apotel, providing sustained pain reduction over 24 hours post-surgery. Moreover, remifentanil offers longer-lasting pain relief and results in lower cumulative narcotic painkiller consumption compared to Apotel.

Keywords: Arthroplasty; Infusion Pumps; Knee; Opioid Tolerance; Pain Management; Remifentanil.