Local infiltration analgesia with ropivacaine does not reduce pain following THA .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(9):10 Acta Orthop. 2015 Dec;86(6):654-8116 patients scheduled to undergo total hip arthroplasty (THA) were randomized to undergo the procedure with or without local infiltration analgesia (LIA) including 0.2% ropivacaine. The purpose of this study was to assess the effectiveness of LIA with ropivacaine (in addition to a multimodal analgesic regimen) on postoperative pain and opioid requirement following THA. The results of this study demonstrated that LIA with ropivacaine did not provide additional analgesic effect and that the consumption of opioids over the first postoperative day was comparable between 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.
3/4
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
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?
Pain management is a primary concern following total hip arthroplasty (THA) as it can affect early postoperative mobilization and rehabilitation. Local infiltration analgesia (LIA) is commonly used as part of a multi-modal analgesia treatment for post-operative pain. However, trials investigating the efficacy LIA with ropivacaine as a part of a multimodal analgesia treatment have been unable to identify additional benefits of its use following THA. The aim of this study was to determine the analgesic effects of LIA with 0.2% ropivacaine through the measurement of pain scores and opioid consumption over the first postoperative day.
¿Cuál era la pregunta principal de la investigación?
In patients undergoing total hip arthroplasty, did single-shot local infiltration analgesia with 0.2% ropivacaine combined with a multimodal analgesic regimen reduce pain and opioid consumption in comparison to control patients not receiving LIA after 48 hours?
- Pain during mobilization in the PACU was not significantly different between groups (3 in both groups , p=0.7). Pain scores during mobilization on the first postoperative day were similar between groups (4 in both groups, p=0.3).
- The median opioid consumption in the PACU was similar between groups. (0 mg [Range: 0-3.1] and 0 mg [Range: 0-5] in the placebo and ropivacaine groups respectively p=0.9). Total oxycodone consumption on the first postoperative day was 20 mg [Range: 10-30] in both groups (p=0.4).
- The median number of hours mobilized was 9 in the placebo group [Range: 7-12] and 9 in the ropivacaine group [Range: 6-11] (p=0.7). The median length of hospital stay was 2 and 3 for the placebo and ropivacaine groups respectively (p=0.5). No statistical significance was noted.
¿Qué es lo que más debo recordar?
Local infiltration analgesia (LIA) with 0.2% ropivacaine did not provide a significant analgesic effect following THA when added to a multimodal analgesic regimen (acetaminophen, NSAID, and glucocorticoid). Additionally, local infiltration analgesia (LIA) with 0.2% ropivacaine did not reduce postoperative opioid consumption or mobilization pain scores.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study indicate that local infiltration analgesia with 0.2% ropivacaine did not provide an additional analgesic effect following THA during mobilization in the post-anesthesia care unit (PACU) or mobilization one day postoperatively. The investigators noted that several similarly structured RCTs examining the effect of LIA following THA have used different pain treatment modalities, further complicating interpretation and comparison of this study's results. Further studies using larger population sizes and other validated and objective pain outcomes are warranted to substantiate current findings.
DESCARGO DE RESPONSABILIDAD
El contenido de esta página tiene únicamente fines informativos y no pretende sustituir el consejo, diagnóstico o tratamiento médico profesional. Si necesita tratamiento médico, busque siempre el consejo de su médico o acuda al servicio de urgencias más cercano. Las opiniones, creencias y puntos de vista expresados por las personas sobre el contenido que se encuentra en esta página no reflejan las opiniones, creencias y puntos de vista de OrthoEvidence.
0 de 4 artículos mensuales GRATIS desbloqueados
