title: Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Fatih Sultan Mehmet Training and Research Hospital, Orthopaedics and Traumatology Department, Istanbul, Turkey.
authors.forename: Barış
authors.initials: B
authors.lastname: Yılmaz
authors.affiliation: Kanuni Sultan Suleyman Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
authors.forename: Baran
authors.initials: B
authors.lastname: Kömür
authors.affiliation: Ankara Oncology Training and Research Hospital, Orthopaedics and Traumatology Department, Ankara, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Aktaş
authors.affiliation: Umraniye Training and Research Hospital, Psychiatry Department, Istanbul, Turkey.
authors.forename: Firdes
authors.initials: F
authors.lastname: Sonnur Yılmaz
authors.affiliation: Trakya University Medical Faculty, Orthopaedics and Traumatology Department, Edirne, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Çopuroğlu
authors.affiliation: Trakya University Medical Faculty, Orthopaedics and Traumatology Department, Edirne, Turkey.
authors.forename: Mert
authors.initials: M
authors.lastname: Özcan
authors.affiliation: Trakya University Medical Faculty, Orthopaedics and Traumatology Department, Edirne, Turkey.
authors.forename: Mert
authors.initials: M
authors.lastname: Çiftdemir
authors.affiliation: Trakya University Medical Faculty, Psychiatry Department, Edirne, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Çopuroğlu
keywords: Alprazolam; anxiety; comorbid pain; depression; total knee arthroplasty.