Adductor canal block for management of postoperative pain after revision knee arthroplasty .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(4):4 PLoS One. 2014 Nov 11;9(11):e11195136 patients scheduled to undergo revision total knee arthroplasty were randomly assigned to adductor canal block with ropivacaine or placebo. The purpose of this study was to evaluate whether an adductor canal block reduced postoperative pain to a significant degree. The primary outcome of interest was VAS pain during knee flexion at 4 hours postoperatively. Results indicated a significantly greater reduction in pain at 4 hours postoperatively in the adductor canal block group than the placebo group. However, due to a large dropout rate, the findings from this trial alone cannot support the use of adductor canal block for the management of postoperative pain after revision total knee arthroplasty.
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)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
4/4
Randomization
3/4
Outcome Measurements
4/4
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
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
As the number of total knee arthroplasty procedures being performed continues to increase, so too are the number of revision surgeries. Typically, a femoral nerve block is used for postoperative pain management after total knee arthroplasty, but it has been associated with weakness in the quadriceps muscle. Instead, an adductor canal block is a sensory nerve block which allows for the preservation of quadriceps muscle strength and mobilization ability. To the authors’ knowledge, no studies regarding postoperative pain management after revision total knee arthroplasty have been done, necessitating this trial comparing the efficacy of adductor canal block and placebo.
Qual era la domanda di ricerca principale?
In patients undergoing revision total knee arthroplasty, does an adductor canal block reduce postoperative pain when compared with placebo?
- VAS pain score during flexion of the knee at 4 hours postoperatively was significantly higher in the placebo group than the adductor canal block group (71 +/- 25 mm vs. 52 +/- 22 mm, respectively; p=0.04).
- There were no between group differences in cumulative morphine consumption from 0-25 h (p=0.48), 0-8 h (p=0.97) and 8-24 h (p=0.95).
- Both groups experienced a similar number of vomiting episodes, ondansetron consumption, and degree of nausea and sedation at all follow-ups.
Che cosa devo ricordare di più?
Adductor canal block significantly reduced VAS pain score at 4 hours postoperatively compared with placebo. Cumulative morphine consumption and adverse events were similar between groups.
Come influenzerà l'assistenza ai miei pazienti?
Based on the findings of this trial, adductor canal block was able to provide adequate pain relief after revision total knee arthroplasty, but between group differences only occurred at 4 hours postoperatively. Due to a large number of dropouts, the results from this study are underpowered and should be interpreted with caution. Future studies will need to assess a larger sample size before adductor canal block can be recommended.
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