RESEARCH ARTICLE


Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression



Barış Yılmaz1, *, Baran Kömür*, 2, Erdem Aktaş3, Firdes Sonnur Yılmaz4, Cem Çopuroğlu5, Mert Özcan5, Mert Çiftdemir5, Elif Çopuroğlu6
1 Fatih Sultan Mehmet Training and Research Hospital, Orthopaedics and Traumatology Department, Istanbul, Turkey
2 Kanuni Sultan Suleyman Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
3 Ankara Oncology Training and Research Hospital, Orthopaedics and Traumatology Department, Ankara, Turkey
4 Umraniye Training and Research Hospital, Psychiatry Department, Istanbul, Turkey
5 Trakya University Medical Faculty, Orthopaedics and Traumatology Department, Edirne, Turkey
6 Trakya University Medical Faculty, Psychiatry Department, Edirne, Turkey


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© Yılmaz et al. ; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Kanuni Sultan Suleyman Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey; Tel: +902124041500; Fax: +902125714790; E-mail: barankomur@gmail.com


Abstract

Purpose:

Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions.

Methods:

Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients’ Knee Society Score and Knee Society Functional Score records.

Results:

A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2.

Conclusion:

Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression.

Keywords: Alprazolam, anxiety, comorbid pain, depression, total knee arthroplasty.