Uso de catéter intraarticular en fast track de artroplastia primaria de rodilla. ¿Supone un avance? / The use of an intraarticular catheter on fast-track primary knee arthroplasty, is it a step forward?

Objetivo. Comparar la eficacia en el control del dolor postoperatorio de pacientes sometidos a artroplastia total de rodilla primaria comparando catéter intraarticular versus epidural. Material y método. Ensayo clínico aleatorizado formado por dos grupos de pacientes: un grupo control con anestesia intradural y un catéter epidural (ropivacaína) y un grupo de intervención con la misma técnica anestésica, a la que se añadió un catéter intraarticular con bomba elastomérica (ropivacaína + dexketoprofeno). Se registraron variables demográficas, anestésicas y quirúrgicas, intensidad del dolor según Escala Verbal Numérica, consumo de opiáceos y complicaciones, balance articular, inicio de la deambulación y estancia hospitalaria. Resultados. Se observó menor incidencia y severidad en la Escala Verbal Numérica en el grupo de intervención y mejor control del dolor postoperatorio (p<0,0014). El balance articular presentó resultados significativos en la flexión y el 74% de estos pacientes deambularon antes de las 36h cuando el grupo control aún no lo había hecho. El 54,1% de pacientes se mostraron «muy satisfechos» a favor del uso del catéter (p>0,001). Por último, la estancia hospitalaria disminuyó, siendo el 33,3% de los pacientes del grupo de intervención dados de alta a las 48h de la intervención, hecho que no sucedió en ninguno de los casos del grupo control. Discusión y conclusiones. El uso del catéter intraarticular como analgesia postoperatoria es una alternativa válida y segura. Disminuye la aparición de efectos secundarios y mejora el balance articular, el inicio de la deambulación y el control del dolor y contribuye a una mayor satisfacción del paciente y a un alta más precoz (AU)

Objective. This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. Material and method. Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen). Data such as demographic, anaesthetic and surgical variables, pain intensity according to Verbal Rating Scale, opioid use and complications, joint balance, onset of walking and hospital stay were recorded. Results. A lower incidence and severity on Verbal Rating Scale and a better control of postoperative pain (p<.0014) were observed in the intervention group. Joint balance also presented significant results in flexion and 74% of these patients started walking before the first 36h and the control group had not yet done so. Regarding patient satisfaction, 54.1% of the patients were "very satisfied" with the use of the catheter (p>.001). Finally, the hospital stay decreased significantly, with 33.3% of intervention group patients discharged within the first 48h compared to none of the control group. Discussion and conclusions. The use of the intraarticular catheter as postoperative analgesia is a useful and safe alternative. It reduces the possibility of side effects. It helps in early improvement of joint balance, onset of walking and control of pain. All of which increase patient satisfaction and result in a shorter period of hospitalisation (AU)

The use of an intraarticular catheter on fast-track primary knee arthroplasty, is it a step forward? / Uso de catéter intraarticular en fast track de artroplastia primaria de rodilla. ¿Supone un avance?

OBJECTIVE: This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. MATERIAL AND METHOD: Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen). Data such as demographic, anaesthetic and surgical variables, pain intensity according to Verbal Rating Scale, opioid use and complications, joint balance, onset of walking and hospital stay were recorded. RESULTS: A lower incidence and severity on Verbal Rating Scale and a better control of postoperative pain (p<.0014) were observed in the intervention group. Joint balance also presented significant results in flexion and 74% of these patients started walking before the first 36h and the control group had not yet done so. Regarding patient satisfaction, 54.1% of the patients were "very satisfied" with the use of the catheter (p>.001). Finally, the hospital stay decreased significantly, with 33.3% of intervention group patients discharged within the first 48h compared to none of the control group. DISCUSSION AND CONCLUSIONS: The use of the intraarticular catheter as postoperative analgesia is a useful and safe alternative. It reduces the possibility of side effects. It helps in early improvement of joint balance, onset of walking and control of pain. All of which increase patient satisfaction and result in a shorter period of hospitalisation.