GENERAL ORTHOPAEDICS
Intraarticular vs. extraarticular ropivacaine infusion following high dose local infiltration analgesia after total knee arthroplasty
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)?
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。
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
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？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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.
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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