AAOS2017: Early pain reduction with peri-incisional injection in femur fracture surgery

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
102 patients with an acute femoral fracture undergoing either fixation or arthroplasty were randomized to the procedure with or without intraoperative peri-incisional injection analgesia. Patients were assessed for pain scores, on a visual analog scale, and narcotic consumption over the first 48 hours postoperatively. Results demonstrated significantly Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Periarticular injection (PAI) analgesia techniques have demonstrated efficacy in managing postoperative pain following elective total joint arthroplasty. In contrast, there is limited evidence evaluating its use in patients undergoing either arthroplasty or fixation for acute trauma. This study sought to evaluate the efficacy of peri-incisional injection analgesia in patients undergoing surgery for a femoral fracture.
What was the principal research question?
In surgery for acute femoral fracture, what is the analgesic efficacy of peri-incisional injection, compared to not injection when assessed over the first 48 hours postoperatively?
Population: 102 patients, 18 years of age or older, with an acute femoral fracture and scheduled for either open reduction and internal fixation, intramedullary nail fixation, or arthroplasty. (n=95 analyzed)
Intervention: Peri-incisional injection group: During surgery, patients were administered an injection of a solution containing 400mg ropivacaine, 0.6mg epinephrine, and 5mg morphine within the superficial and deep tissues. (n=45)
Comparison: Control group: Patients were not administered peri-incisional injection for postoperative analgesia. (n=50)
Outcomes: The primary outcome was pain on a visual analog scale. Secondary outcomes were narcotic consumption and the incidence of narcotic-related adverse events,
Methods: RCT; Patient- and assessor-blinded
Time: Pain was assessed at 4-hour intervals for 48 hours postoperatively. Narcotic consumption was assessed at 8-hour intervals for 48 hours postoperatively.
What were the important findings?
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What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.