TKA: Similar pain outcomes for local infiltration anesthesia and continuous femoral block .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):33 Acta Orthop. 2011 Aug;82(4):441-7. Epub 2011 May 1140 patients undergoing total knee arthroplasty with spinal anaesthesia were randomized to receive either a local infiltration of anaesthesia or a continuous femoral block. The primary outcome was pain at rest and at movement. The results at 24 hours postoperatively indicated both interventions produced comparable analgesic effect. Local infiltration of anaesthesia may be preferred, because it is more cost-effective and easier to execute.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
4/4
Randomization
2/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Total knee arthroplasty (TKA) can produce severe postoperative pain, which may delay recovery. There are a number of pain treatments present, such as femoral nerve block or epidural analgesia. Local infiltration analgesia (LIA) has become a popular choice in pain management, but its effectiveness has yet to be fully evaluated. This study examines the outcomes of pain when patients undergoing total knee arthroplasty receive either a local infiltration of anaesthesia or a continuous femoral block.
¿Cuál era la pregunta principal de la investigación?
What are the outcomes in pain with an intervention involving a peri- and intra-articular infiltration of anesthesia or a continuous femoral block in patients undergoing total knee arthroplasty at 24 hours postoperatively?
- The local infiltration anaesthesia group (Group LIA) reported lower average pain at rest compared to the femoral nerve block group. (Group F) (Group LIA: 1.6, Group F: 2.2)
- 7/19 patients in Group F reported a pain intensity of >7 upon movement compared to only 1/20 patients in Group LIA. (p=0.04, Fisher's exact test)
- Both groups indicated comparable consumption of morphine per kg. (Femoral block: 0.4 (0.3-0.5) mg/kg; LIA: 0.3 (0.2-0.4) mg/kg)
- No adverse events were reported within the 24 hour postoperative study period.
¿Qué es lo que más debo recordar?
Both the local infiltration anaesthesia intervention and the femoral nerve block interventions provided good analgesic effect in patients after total knee arthroplasty. However, local infiltration anaesthesia may be a preferred option, because of its cost-effectiveness and ease of administration compared to the femoral nerve block.
¿Cómo afectará esto al cuidado de mis pacientes?
Both local infiltration anaesthesia and femoral nerve block described in this study provide good analgesia following TKA. However, local infiltration anaesthesia may be a preferred treatment due to lower costs and the ease to perform this technique.
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