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Injury. 2017 Dec;48(12):2754-2761. doi: 10.1016/j.injury.2017.10.024. Epub 2017 Oct 10.

Postoperative continuous-flow cryocompression therapy in the acute recovery phase of hip fracture surgery-A randomized controlled clinical trial.

Author information

1
Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands. Electronic address: nleegwater@spaarnegasthuis.nl.
2
Department of Surgery, Section of Traumasurgery, VU University Medical Centre, Amsterdam, The Netherlands.
3
Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
4
Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands.
5
Department of Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands.
6
Department of Orthopaedics, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands.
7
Department of Orthopaedics, Acibadem International Medical Center, Amsterdam, The Netherlands.
8
Department of Orthopaedics, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
9
Department of Surgery, Section of Traumasurgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
10
Department of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University, Amsterdam, The Netherlands; Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
11
Department of Orthopaedics, VU University Medical Centre, Amsterdam, The Netherlands.
12
Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands.

Abstract

BACKGROUND:

The acute recovery phase after hip fracture surgery is often complicated by severe pain, postoperative blood loss with subsequent transfusion, and delirium. Prevalent comorbidity in hip fracture patients limit the use of opioid-based analgesic therapies, yielding a high risk for inferior pain treatment. Postoperative cryotherapy is suggested to provide an analgesic effect, and to reduce postoperative blood loss. In this prospective, open-label, parallel, multicentre, randomized controlled, clinical trial, we aimed to determine the efficacy of continuous-flow cryocompression therapy (CFCT) in the acute recovery phase after hip fracture surgery.

METHODS:

Patients with an intra or extracapsular hip fracture scheduled for surgery were included. Subjects were allocated to receive postoperative CFCT or usual care. The primary endpoint was numeric rating scale (NRS) pain the first 72 postoperative hours. Secondly, analgesic use; postoperative haemoglobin change and transfusion incidence; functional outcome; length of stay; delirium incidence; location of rehabilitation; patient-reported health outcome; complications and feasibility were assessed.

RESULTS:

Sixty-one subjects in the control group, and 64 subjects in the CFCT group were analysed. Within the CFCT group, post treatment NRS pain declined 0.31 (p=0.07) at 24h, 0.28 (p=0.07) at 48h, and 0.47 (p=0.002) at 72h relative to pre treatment NRS pain. Sensitivity analysis at 72h showed that NRS pain was 0.92 lower in the CFCT group when compared to the control group (1.50 vs. 2.42; p=0.03). Postoperative analgesic use was comparable between groups. Between postoperative day one and three haemoglobin declined 0.29mmol/l in the CFCT group and 0.51mmol/l in controls (p=0.06), and transfusion incidence was comparable. The timed up and go test and length of stay were also comparable between both groups. Complications, amongst delirium and cryotherapy-related adverse events were not statistically significantly different. Discharge locations did not differ between groups. At outpatient follow-up subjects did not differ in patient-reported health outcome scores. Subjects rated CFCT satisfaction with an average of 7.1 out of 10 points.

CONCLUSIONS:

No evidence was recorded to suggest that CFCT has an added value in the acute recovery phase after hip fracture surgery. If patients complete the CFCT treatment schedule, a mild analgesic effect is observed at 72h.

KEYWORDS:

Analgesia; Complications; Cryotherapy; Delirium; Functional outcome; Haemoglobin; Hip fracture; Induced hypothermia; Opioid analgesics; Pain

PMID:
29079365
DOI:
10.1016/j.injury.2017.10.024
[Indexed for MEDLINE]

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