ARTHROPLASTY
Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):33 Acta Orthop. 2011 Aug;82(4):441-7. Epub 2011 May 1140 patients undergoing total knee arthroplasty with spinal anaesthesia were randomized to receive either a local infiltration of anaesthesia or a continuous femoral block. The primary outcome was pain at rest and at movement. The results at 24 hours postoperatively indicated both interventions produced comparable analgesic effect. Local infiltration of anaesthesia may be preferred, because it is more cost-effective and easier to execute.
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
2/4
Outcome Measurements
2/4
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？
Total knee arthroplasty (TKA) can produce severe postoperative pain, which may delay recovery. There are a number of pain treatments present, such as femoral nerve block or epidural analgesia. Local infiltration analgesia (LIA) has become a popular choice in pain management, but its effectiveness has yet to be fully evaluated. This study examines the outcomes of pain when patients undergoing total knee arthroplasty receive either a local infiltration of anaesthesia or a continuous femoral block.
主な研究課題は何ですか？
What are the outcomes in pain with an intervention involving a peri- and intra-articular infiltration of anesthesia or a continuous femoral block in patients undergoing total knee arthroplasty at 24 hours postoperatively?
重要な知見は？
- The local infiltration anaesthesia group (Group LIA) reported lower average pain at rest compared to the femoral nerve block group. (Group F) (Group LIA: 1.6, Group F: 2.2)
- 7/19 patients in Group F reported a pain intensity of >7 upon movement compared to only 1/20 patients in Group LIA. (p=0.04, Fisher's exact test)
- Both groups indicated comparable consumption of morphine per kg. (Femoral block: 0.4 (0.3-0.5) mg/kg; LIA: 0.3 (0.2-0.4) mg/kg)
- No adverse events were reported within the 24 hour postoperative study period.
最も覚えておくべきことは？
Both the local infiltration anaesthesia intervention and the femoral nerve block interventions provided good analgesic effect in patients after total knee arthroplasty. However, local infiltration anaesthesia may be a preferred option, because of its cost-effectiveness and ease of administration compared to the femoral nerve block.
それが私の患者ケアにどのように影響するか？
Both local infiltration anaesthesia and femoral nerve block described in this study provide good analgesia following TKA. However, local infiltration anaesthesia may be a preferred treatment due to lower costs and the ease to perform this technique.
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