Decreased pain with double wound infiltration of analgesia for total hip replacement .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):9 Acta Orthop. 2007 Apr;78(2):187-9240 patients undergoing total hip replacement (THR) surgery were randomized into two groups to examine the outcomes of pain and postoperative requirement for analgesia. Both groups received wound infiltration at the end of surgery as well as through an intraarticular catheter 24 hours postoperatively, and both were blinded to treatment. The intervention group received a solution of ketorolac, ropivacaine and adrenaline, while the control group received a saline solution. Results showed that the intervention group had less pain up to 2-weeks postoperatively and were more satisfied compared to the control group. Patients receiving the analgesic also had less joint stiffness and better function at 1 week postoperatively.
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Pain management and comfort are important factors for optimal mobilization after total hip replacement (THR) surgery. Postoperative pain can prolong immobilization and hospital stay, so it is important for patients to receive an effective postoperative analgesic. This study examined double wound (operative and postoperative) infiltration with analgesia in patients undergoing THR surgery.
Qual era a principal questão de investigação?
Does the use of double (operative and postoperative) infiltration of analgesia result in decreased pain and faster mobilization after total hip replacement surgery?
- The intervention group had significantly less pain compared to the control group up to 2 weeks postoperatively.
- The intervention group had a lower use of analgesics up to the fourth postoperative day.
- The intervention group had better physical function (WOMAC physical function subscale) (p=0.02) and less joint stiffness (WOMAC joint stiffness subscale) (p=0.04) at 1 week postoperatively, but no significant differences were seen at 2, 4, and 6 weeks.
- Patients from the intervention group were discharged from the hospital at a median of 2.6 days compared to 2.8 days for the control group. (P>0.05)
- There was a statistically significant difference in patient satisfaction between the intervention and control group, with greater satisfaction seen in the intervention group 8 hours postoperatively (16 patients compared to 8; p<0.05), on day 1 (15 patients compared to 6; p<0.05) and in weeks 1, 2 and 4.
- No adverse effects were seen from the treatment group.
De que é que me devo lembrar mais?
Peroperative and postoperative wound infiltration of analgesia reduces pain as well as the analgesic requirement after total hip replacement surgery. This may allow for faster postoperative mobilization.
Como é que isto afectará o tratamento dos meus doentes?
Patients receiving double wound infiltration of analgesia may have faster mobilization postoperatively after total hip replacement surgery. Patients may also be more satisfied postoperatively when receiving the double wound infiltration procedure compared to the control group. There is interest in performing further studies to examine different study designs, such as continuous or frequent injections
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