ARTHROPLASTY
Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: A randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):23 Acta Orthop. 2007 Apr;78(2):180-680 patients with osteoarthritis undergoing total hip replacement surgery were randomized to receive a combination of infiltration with either a single intraarticular injection, or epidural infusion, to compare pain relief in individuals post-surgery. The findings indicated that infiltration with one intraarticular injection resulted in multiple benefits, including improved pain relief, reduced narcotic consumption, decreased occurrence of side effects, improved walking ability, as well as decreased time of hospital stay.
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
2/4
Randomization
2/4
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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Following total hip replacements, post-operative relief can be provided through a variety of methods, some of which include intravenous analgesia, epidural analgesia, and peripheral nerve block techniques. With the goal of reducing the occurrence of side effects while still maintaining sufficient pain relief, the combination of local infiltration and single-shot injections has been introduced. Infiltration combined with a single-shot intraarticular injection in the hip joint has not been compared with epidural infusion. Therefore, this study was needed to investigate the effects of this combined technique on analgesia in patients undergoing a total hip replacement.
主な研究課題は何ですか？
Does the use of infiltration combined with a single-shot intraarticular injection result in increased analgesia and improved overall patient outcome postoperatively, as compared to epidural infusion, in patients undergoing a total hip replacement?
重要な知見は？
- Pain scores measured by VAS from 2 to 20 hours postoperative were similar between the two groups (p=0.2). However, pain scores in group A were significantly lower compared to group E in the 24-28 hour period (8 [IQR 12-33.5] vs. 20 [3.5-39]; p=0.02) and the 52-96 hour period (0 [IQR 0-0] vs. 11 [5.5-24]; p<0.001).
- During the first 20 hours patients in group A had reduced narcotic consumption compared to group E (17.4 mg [IQR 0-40.5] vs. 26 mg [IQR 21-52]; p=0.004). Total consumption over the 96 hour period was also significantly lower in group A vs group E (258 [IQR 167–366] vs. 324 [IQR 221–543]; p=0.05).
- Eight hours after surgery, walking ability was improved in group A in comparison to group E (33/38 vs. 13/37; p<0.001). Bromage scores also favoured group A over group E (p<0.001).
- Group A had a reduced length of hospital stay compared to Group E; 4.5 (IQR 3-6) and 7 (IQR 5.5-7), respectively (p<0.001).
- With the exception of nausea (p=0.1), group A had lower recurrence of vomiting (p=0.05), urinary retention (p=0.001), itch (p=0.01), and constipation (p<0.001). Additionally, 1 patient in each group developed deep vein thrombosis.
最も覚えておくべきことは？
Patients who received the combination of wound infiltration and one intraarticular injection following total hip replacement, had reduced narcotic consumption, decreased occurrence of side effects, shorter length of stay in hospital, as well as improved walking ability, when compared to continuous epidural infusion.
それが私の患者ケアにどのように影響するか？
The results of this study indicated that the combination of wound infiltration with a single intraarticular injection provides numerous benefits to patients undergoing total hip arthroplasty. It is important to note that no conclusions were made regarding the risk for deep infection with this technique. Additional studies are needed to confirm these results.
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