ARTHROPLASTY
No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip 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(2):4 Acta Orthopaedica 2011; 82 (2): 315–320.60 patients undergoing non-cemented total hip arthroplasty and receiving standard pain treatment in the form of local infiltration analgesia (LIA) were randomized to receive either placebo or a postoperative solution of local infusion analgesia (LINFA). Postoperative assessments of pain, opioid consumption, and length of hospital stay indicated similar results for both 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
4/4
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？
The use of LINFA postoperatively to supplement LIA, following total hip arthroplasty, has increased significantly throughout clinical practices, as a means to expedite patient recovery. There currently exists a lack of RCTs regarding the efficacy of LINFA and supporting its use postoperatively.
主な研究課題は何ですか？
Does a postoporative LINFA regimen lead to reduced nausea and expedited patient recovery, as compared to a placebo control in patients undergoing total hip arthroplasty for primary osteoarthritis?
重要な知見は？
- There was a reduction in nausea and vomiting in the LINFA group (p=.02) in the short term (days 1 and 2)
- There was not a significant difference between the two groups in terms of the WOMAC pain scale, opioid consumption, and tiredness
- There was not a statistically significant difference detected in terms of length of stay; however, the results were trending towards a reduction in stay in the LINFA group (p=.09)
最も覚えておくべきことは？
There was no significant difference established with respect to pain management, length of stay or tiredness. There was some indication that LINFA was associated with reduced nausea and vomiting during the early post-operative stage.
それが私の患者ケアにどのように影響するか？
The authors contend that although LIA with postoperative LINFA has become common clinical practice, there exists no documented benefit of LINFA with regards to patient recovery, pain, or tiredness. However, small sample size of this study should be taken into account.
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