A retrospective analysis of the effects of different analgesics on the pain of patients with traumatic thoracolumbar fractures in the peri-treatment period

Abstract

Objective: To analyze and compare the effects of peri-treatment analgesics on acute and chronic pain and postoperative functional recovery of patients with thoracolumbar fractures, so as to guide the clinical drug use.

Methods: Seven hundred nineteen patients with thoracolumbar fractures were collected and divided into acetaminophen dihydrocodeine, celecoxib, and etoricoxib groups. The main indicators were the degree of postoperative pain (visual analog scale (VAS)), the incidence of chronic pain and postoperative functional recovery (Oswestry dysfunction index (ODI) and Japanese Orthopedics Association score (JOA)), which were continuously tracked through long-term telephone follow-up. The correlation analysis of ODI-pain score, peri-treatment VAS score, and ODI index was performed, and bivariate regression analysis was conducted to understand the risk factors for chronic pain.

Results: Regression analysis showed that severe spinal cord injury and peri-treatment use of acetaminophen dihydrocodeine were both one of the risk factors for postoperative chronic pain. But there were no statistically conspicuous differences in basic characteristics, preoperative injury, and intraoperative conditions. Compared with the other two groups, patients in the acetaminophen dihydrocodeine group had longer peri-therapeutic analgesic use, higher pain-related scores (VAS 1 day preoperatively, VAS 1 month postoperatively, and ODI-pain 1 year postoperatively), higher VAS variation, higher incidence of chronic pain 1 year after surgery, and higher ODI index. And other ODI items and JOA assessments showed no statistically significant differences. In addition, the correlation analysis showed that the peri-treatment pain score was correlated with the severity of postoperative chronic pain.

Conclusion: Although the peri-treatment analgesic effect of acetaminophen dihydrocodeine is good, it is still necessary to combine analgesics with different mechanisms of action for patients with severe preoperative pain of thoracolumbar fracture, so as to inhibit the incidence of postoperative chronic pain and improve the quality of postoperative rehabilitation.

Keywords: Acetaminophen dihydrocodeine; Celecoxib; Etoricoxib; Pain degree; Traumatic thoracolumbar fracture.

Fig. 1

Basic characteristics of the patients. a Number of different genders. b Percentage of different genders. c Age value (years old). d Number of different age groups. e Percentage of different age groups. f Height (cm). g Body weight (kg). h BMI value (kg/m²). i Number of different body types. j Percentage of different body types. k Number of different occupations. l Percentage of different occupations. m Percentage of different comorbidities. n Number of groups of different altitudes of long-term residence. o Percentage of groups with different altitudes of long-term residence

Fig. 2

Assessment of the patient’s injury and condition, duration of perioperative analgesics, and pain score. a Percentage of different causes of injury. b Percentage of different injured segments. c Time from injury to operation (days). d Preoperative Tlics score. e Preoperative percentages of different Frankel grades. f Operation time (h). g Intraoperative blood loss (ml). h Time of preoperative analgesic drug use (days); i Use time of postoperative analgesics (days). j VAS rest assessment 1 day before surgery. k Number of different VAS scores before surgery. l VAS at resting assessment 1 month after surgery. m Number of different VAS scores after surgery. n Comparison of VAS differences before and after operation. * The difference between codeine and celecoxib groups was statistically significant, p < 0.01. # The difference between the codeine and etoricoxib groups was statistically significant, p < 0.01. & The difference between codeine and celecoxib groups was statistically significant, p < 0.01

Fig. 3

Postoperative ODI score. a ODI-1 (pain assessment). b ODI-2 (personal life). c ODI-3 (weight lifting). d ODI-4 (walking). e ODI-5 (seated). f ODI-6 (walking). g ODI-7 (sleeping). h ODI-8 (sexual life). i ODI-9 (social life). j ODI-10 (travel). k ODI index number. l The number of segments of different ODI indexes. m Percentage of different ODI index segments. *There were significant differences between the codeine group and the celecoxib group, p < 0.01. #There were significant differences between the codeine group and the etoricoxib group, p < 0.01

Fig. 4

Postoperative walking condition and JOA score. a The number of different days from postoperative to walking. b Percentage of different days from postoperative to walking. c The number of different distances walked after surgery. d The percentage of different distances walked after surgery. e The number of different degrees of lumbar and leg pain assessed by the JOA in each subgroup. f The percentage of different degrees of lumbar and leg pain assessed by the JOA in each subgroup. g The number of different states of gait assessed by the JOA in each subgroup. h The percentage of different states of gait assessed by the JOA in each subgroup. i The number of urinary function limitations assessed by the JOA in each subgroup. j The percentage of urinary function limitations assessed by the JOA in each subgroup