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- Title
Reduced opiate use after total knee arthroplasty using computer-assisted cryotherapy.
- Authors
Thijs, Elke; Schotanus, Martijn G. M.; Bemelmans, Yoeri F. L.; Kort, Nanne P.
- Abstract
<bold>Purpose: </bold>Despite multimodal pain management and advances in anesthetic techniques, total knee arthroplasty (TKA) remains painful during the early postoperative phase. This trial investigated whether computer-assisted cryotherapy (CAC) is effective in reduction of pain and consumption of opioids in patients operated for TKA following an outpatient surgery pathway.<bold>Methods: </bold>Sixty patients scheduled for primary TKA were included in this prospective, double-blind, randomized controlled trial receiving CAC at 10-12 °C (Cold-group, n = 30) or at 21 °C (Warm-group, n = 30) during the first 7 days after TKA according to a fixed schedule. All patients received the same pre-, peri- and postoperative care with a multimodal pain protocol. Pain was assessed before and after every session of cryotherapy using the numerical rating scale for pain (NRS-pain). The consumption of opioids was strictly noted during the first 4 postoperative days. Secondary outcomes were knee swelling, visual hematoma and patient reported outcome measures (PROMs). These parameters were measured pre-, 1, 2 and 6 weeks postoperatively.<bold>Results: </bold>In both study groups, a reduction in NRS-pain after every CAC session were seen during the postoperative period of 7 days. A mean reduction of 0.9 and 0.7 on the NRS-pain was seen for respectively the Cold- (P = 0.008) and Warm-group (n.s.). A significant (P = 0.001) lower number of opioids were used by the Cold-group during the acute postoperative phase of 4 days, 47 and 83 tablets for respectively the Cold and Warm-group. No difference could be observed for secondary outcomes and adverse effects between both study groups.<bold>Conclusions: </bold>Postoperative CAC can be in added value in patients following an outpatient surgery pathway for TKA, resulting in reduced experienced pain and consumption of opioids during the first postoperative days.
- Subjects
TOTAL knee replacement; PAIN management; COLD therapy; NARCOTICS; POSTOPERATIVE care
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2019, Vol 27, Issue 4, p1204
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-018-4962-y