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.

Background: There are few literatures analyze the effects of traumatic thoracolumbar vertebral fractures on prognosis pain and functional recovery from the perspective of analgesics used in the perioperative period, and lack of clinical guidance on the application of analgesics for its surgery.Objective: To analyze the effects of peri-treatment analgesics on pain and recovery status of patients with thoracolumbar fractures combined with network pharmacology.Methods: 719 patients with thoracolumar fractures were collected and divided into acetaminophen dihydrocodeine group (n=476), celecoxib group (n=130) and etoricoxib group (n=113) according to the use of analgesics. The visual analogue scale (VAS) was used to measure the degree of pain the number of days of the use of three analgesics, the postoperative Oswestry dysfunction index (ODI) scores and some Japanese orthopedics Association score (JOA) were recorded. The targets of three analgesics were obtained by Drugbank, and the target of acute pain caused by fracture is obtained by Genecards, then Venn diagram of the intersection genes was drawn through Venn. Protein interaction mapping (PPI) was obtained by using STRING database, the functional enrichment analysis of Gene Ontology (GO) and the enrichment analysis of Kyoto Encyclopedia of Genes and Genomics (KEGG) pathway were carried out based on Metascape database.Results: The codeine group was higher than celecoxib and etoricoxib groups in the number of days of preoperative and postoperative analgesic use, VAS score difference on the preoperative and postoperative, and postoperative ODI index (all P<0.01). There exist no statistically conspicuous differences among the three groups in basic characteristics, injury and intraoperative conditions, ODI score except ODI index, three JOA marks, and postoperative walking ability (P>0.05). Identify 3332 disease targets. PPI network analysis identified OPRM1, OPRK1, TRPV1, PTGS1 and PTGS2 as the core targets for acetaminophen dihydrocodeine in the treatment. Conclusion: If multiple analgesic modes are adopted in the perioperative analgesic use, and the use of acetaminophen dihydrocodeine in combination with anti-inflammatory analgesics, the duration of analgesic use is expected to be shortened as far as possible to reduce the pain degree in postoperative recovery, providing a reference for the optimal use of anesthetics for clinical traumatic thoracolumbar fractures.