[Pain therapy for the lower extremities]

Pain experience and functional outcome of inpatient versus outpatient anterior cruciate ligament reconstruction, an equivalence randomized controlled trial with 12 months follow-up

BACKGROUND

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) has traditionally been performed in an inpatient setting. Outpatient treatment may offer the advantages of cost reduction and higher patient satisfaction.

HYPOTHESIS/PURPOSE

We investigated whether ACL reconstruction in an outpatient setting is equally safe as in an inpatient setting and whether comparable functional outcomes can be achieved. We hypothesized that the outcomes of outpatient ACL reconstruction result in similar outcomes as inpatient ACL reconstruction.

STUDY DESIGN

A prospective randomized controlled trial was conducted at one centre.

METHODS

Forty-six patients were randomized to outpatient treatment or a 2-day admission after ACL reconstruction. The functional outcome was evaluated with the Lysholm, Tegner and International Knee Documentation Committee scores. Safety of the procedures was judged according to pain experience and readmission rate. The duration of follow-up was 1 year after ACL reconstruction. The patients were provided with a simple postoperative analgesic protocol. The linear mixed effect model for repeated measures was used for testing the differences between the study groups.

RESULTS

No significant differences were found between the study groups in all the outcome measures. No readmissions were recorded related to pain. One complication was recorded in the outpatient group versus three in the inpatient group.

CONCLUSION

This study indicates that outpatient care after ACL reconstruction yields comparable functional results and postoperative pain experience as inpatient care and is a safe option. A simple analgesic protocol provides adequate pain relief during the postoperative phase.

LEVEL OF EVIDENCE

I.

Preemptive analgesia with intra-articular pethidine reduces pain after arthroscopic knee surgery

Background:

Postoperative pain relief is important in procedures of the lower extremity. Several previous studies have evaluated the efficacy of intra-articular (IA) pethidine as a compound, which has local anesthetic and opioid agonist properties, on postoperative pain relief in arthroscopic knee surgery (AKS). This study compared the postoperative analgesic effect of pre- and post-surgical IA pethidine administration in AKS.

Materials and Methods:

Seventy-five patients of American Society of Anesthesiologists (ASA) I and II undergoing AKS with general anesthesia were enrolled in this double-blind study. Patients were randomized in three equal groups to receive either 50 mg IA pethidine before surgical incision incision and saline after skin closure (PS), saline before surgical incision and pethedine after skin closure (SP), and only saline at two different times (SS). In each patient with operated knee joint, pain at rest and joint movement was evaluated at 1, 2, 6, 12, and 24 h after surgery completion using Visual Analog Scale (VAS). Data were analyzed using analysis of variance (ANOVA)-repeated measure, t-paired, and Chi-square tests.

Results:

Postoperative pain score at rest and joint movement in PS group was significantly lower than those in other groups. The time (Mean ± SD) between completion of operation and patient's request for morphine, total morphine consumption (Mean ± SD) in postoperative 24 h, and the numbers of patients requesting analgesic in PS, SP, SS, groups were: 5.2 ± 1.3, 3.3 ± 1.5, and 2 ± 1.3 h (P < 0.05); 4.4 ± 2.4, 8.7 ± 2, and 11.6 ± 4.4 mg (P < 0.05); 11, 18, and 21 persons (P < 0.05), respectively.

Conclusion:

The present study shows that preemptive intra-articular pethidine 50 mg injection is more effective than preventive injection for postoperative pain relief at rest and joint movement in arthroscopic knee surgery.

[Implementation of standardized postoperative pain therapy for orthopaedic patients. Comparison between unsystematic and standardized pain therapy]

BACKGROUND

The painless clinic and postoperative pain therapy are currently major issues in the management of surgical procedures. The aim of this study was to evaluate the benefit of a standardized pain therapy on the postoperative pain level after orthopaedic procedures.

PATIENTS AND METHODS

We investigated two different groups of patients who underwent an orthopaedic surgical procedure. Group 1 (n = 249) received a pain therapy which was based on an individual and surgery-dependent concept whereas group 2 (n = 243) was treated with a standardized pain therapy concept. The effect of the treatment was monitored with a VAS-based protocol.

RESULTS

Up to day 9 after surgery there was a significant difference between the two groups in regard to the postoperative pain. The patients of group 2 had less pain but had more unwanted side effects caused by the pain therapy during the first 3 days after surgery. Mobility and mental disposition were positively affected.

CONCLUSION

The implementation of a standardized pain therapy is successful in reducing postoperative pain. Mobility and mental disposition are also influenced positively. As a consequence the incidence of unwanted side effects is rising.