Intraarticular ropivacaine infusion reduces pain intensity during mobilization after TKA .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):135 Acta Orthop. 2011 Dec;82(6):692-8. Epub 2011 Oct 2536 patients with rheumatoid arthritis undergoing total knee arthroplasty were randomized to receive either intra-articular or extra-articular continuous infusion of local anaesthetics. Patients were assessed in terms of patient-controlled analgesia consumption and pain intensity during mobilization. The results demonstrate that patients receiving intra-articular infusion had decreased pain intensity during first exercises compared to the extra-articular infusion group. These findings indicate the potential for improving post-operative mobilization. However, there were no differences in pain relief at rest between the two treatment groups.
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
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
5/5
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?
Approximately 66% of patients experience severe pain following total knee arthroplasty. Optimal pain relief must encompass an intervention that is delivered pre-operatively, peri-operatively, as well as post-operatively. Local infiltration and a single-shot injection or the continuous infusion of local anaesthetics is considered an effective alternative method to epidural analgesia and femoral block. Catheter insertion to facilitate continuous infusion of local anaesthetics, performed post-operatively, is an effective substitute for local infiltration. However, the optimal site of local anaesthetic administration is unknown, therefore, indicating the need for this study.
¿Cuál era la pregunta principal de la investigación?
What are the effects of either intra-articular or extra-articular continuous local anaesthetic infusion, on post-operative pain, in patients that have undergone total knee arthoplasty, measured at 48 hours?
- At 48 hours post-operatively, the overall patient-controlled analgesia consumption of morphine was similar between both treatment groups.
- There was no difference in the VAS score between groups during rest or with movement.
- There was greater physiotherapist satisfaction regarding the first mobilization in the patients receiving intra-articular infusion (p<0.05). At 48 hours post-operatively, patients receiving continuous intra-articular infusion with Ropivacaine had lower mean scores during exercise (p<0.07). Severe pain upon mobilization (VAS score greater than 7) occurred in 11 patients in the extra-articular group compared to 3 patients in the intra-articular group (p=0.03).
- No toxic side effects or post-operative complications, resulting from wound healing, were observed.
¿Qué es lo que más debo recordar?
Continuous intra-articular infusion with ropivacaine was effective in reducing pain intensity during first exercises. Therefore, early post-operative mobilization (within 24 hours post-op) could be improved following TKA. However, intra-articular infusion was not superior to extra-articular infusion with respect to pain relief at rest.
¿Cómo afectará esto al cuidado de mis pacientes?
Future studies with larger sample sizes are required to provide a more accurate comparison of outcomes between groups and to additionally compare complications rates.
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