Monitoring of remote transmission for postoperative perineural analgesia after major orthopedic surgery: a multicenter, randomized, parallel-group and controlled trial

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J Clin Anesth. December 1, 2021; 77: 110618. doi: 10.1016 / j.jclinane.2021.110618. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: After surgery, patients reported that delay in getting help was the main contributor to poorly controlled pain. This study aimed to compare the effectiveness of patient management through two communication modalities: teletransmission (RT) versus bedside control (BC). We hypothesized that the use of remote technology for pump programming may provide the best postoperative infusion pattern for patient self-report of pain and adverse events.

DESIGN: A multicenter, randomized, parallel-group controlled trial.

SETTING: Department of anesthesiology and orthopedic surgery department of three university hospitals.

PATIENTS: Eighty patients undergoing orthopedic surgery with patient-controlled postoperative perineural analgesia were included.

INTERVENTIONS: Two groups (n = 40 for each group) were formed by randomization. In the postoperative period, perineural analgesia was followed via an RT or BC system for 72 h.

MEASURES: A nurse assessed daily pain, sensory and motor blocks, and adverse events. The patients filled out a questionnaire three times a day and alerted to any problem depending on the group (RT system or nursing follow-up). On the third postoperative day, the nurse removed the catheter, completed the final assessment, and collected historical pump data. The shorter response time of a physician to modify the patient’s control analgesia (PCA) program was the primary endpoint.

RESULTS: Of the 80 patients, 71 were analyzed (34 were randomized to the RT group and 37 to the BC group). Fifty-eight pump setting changes were noted. Analysis of repeated assessments shows that the mean time (SD) to change PCA pump settings was significantly lower in the RT group (20 min (22.3 min)) than in the BC group (55.9 min) (71.1 min)); mean difference [95% CI], -35.9 minutes [-74.3 to 2.4]); estimate [95% CI], -34 [-63 to -6], p = 0.011). Pain relief, sensory and motor blocks did not differ between groups: estimate [95% CI], 0.1 [-0.4 to 0.6], p = 0.753; 0.5 [-0.4 to 1.4], p = 0.255; 0.9 [-0.04 to 1.8], p = 0.687, respectively. = -34 [-63 to -6], p = 0.011). Ropivacaine consumption, nurse workload, and pain regimen cost decreased in the RT group. No difference was noted in satisfaction scores or complication rates.

CONCLUSIONS: Physician response time to change the PCA program when necessary was shorter for patients using RT and physician alerts were more frequent compared to spot checks performed by nurses. RT helped reduce nurse workload, ropivacaine consumption, and costs, but did not affect postoperative pain relief, complication rate, or patient reported satisfaction score.

IRB CONTACT DETAILS: Committee for the Protection of Persons, Sud Méditerranée III, Montpellier-Nîmes, France, EudraCT registration number A01698-35.

CLINICAL TRIAL NUMBER: ClinicalTrials.gov ID: NCT02018068 PROTOCOL: The complete trial protocol can be viewed at the Department of Anesthesiology and Critical Care Medicine, Medical Research and Statistics Unit, CHU Lapeyronie, Avenue Doten G Giraud, Montpellier, France. [email protected]

PMID: 34863052 | DOI: 10.1016 / j.jclinane.2021.110618


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