ABSTRACT
Purpose: Adherence to postoperative protocols is an integral perioperative intervention that impacts surgical outcomes. The focus of this study was to identify the baseline postoperative instruction retention of our traditional written format and compare that with the retention when using an audiovisual adjunct. We hypothesize that the addition of audiovisual adjuncts would result in greater patient retention of their postoperative instructions. Methods: Sixty consecutive adult patients undergoing soft tissue procedures of the hand and wrist were enrolled prospectively at a single institution. Patients were randomized to receive postoperative instructions with either a written or an audiovisual adjunct format. Two days after surgery, a blinded investigator contacted the participants to administer a standardized phone questionnaire. Responses were recorded, and the data were analyzed by another blinded team member. Analysis was performed using χ 2 and Student t tests as appropriate. Results: Fifty patients were included in the final analysis. The written group scored an average retention of 80%, whereas the audiovisual group showed a retention score of 85%. Demographic analysis of men versus women, and patients <60 versus >60 years of age did not demonstrate significant score differences. The subgroup analysis of patients receiving local anesthesia alone demonstrated significantly higher rates of percent correct and perfect recall in the audiovisual compared with the written-only group (87.5 vs 80.5 and 44% vs 7%, respectively). Conclusions: For patients undergoing common soft tissue procedures of the hand, the addition of audiovisual supplementation to written instructions, especially in those undergoing wide awake, local anesthesia, no tourniquet procedures, is associated with higher rates of retention of a patient's postoperative instructions. The specific improvement in the local anesthesia cohort is especially relevant today due to an increased prevalence of wide awake, local anesthesia, no tourniquet style procedures, and the increasing reliance on patient engagement in postoperative care. Type of study/level of evidence: Randomized control trial; Diagnostic Level 2b.
ABSTRACT
Introducción: El dolor posquirúrgico es uno de los retos más importantes en cirugía, los estudios comparativos con ketorolaco en pacientes con cirugía de corta estancia se han restringido generalmente a la administración intravenosa. Por lo tanto, comparamos la eficacia analgésica de ketorolaco sublingual y metamizol en cirugía de corta estancia. Material y métodos: Ensayo clínico controlado ciego simple; los pacientes recibieron 30 mg de ketorolaco sublingual o 1 g de metamizol endovenoso, cada ocho horas, durante las primeras 24 horas posoperatorio. Se evaluó dolor con la escala análoga visual (EVA). También fueron evaluados los efectos colaterales. Para el análisis estadístico se utilizó t de dos colas o U de Mann-Whitney y la prueba exacta de Fisher o χ2, además del cálculo de reducción de riesgo absoluto, razón de momios (OR), intervalo de confianza a 95 %, reducción del riesgo relativo y número necesario a tratar. Resultados: El consumo de analgésico suplementario fue mayor en el grupo de metamizol pero sin diferencia significativa (p = 0.286). Durante el estudio, la EVA promedio fue menor para ketorolaco que para metamizol, sobre todo a las ocho horas de posoperatorio, pero sin diferencia estadística (p = 0.06). La reducción del riesgo absoluto para cuadros de dolor severo fue de casi 5 % (OR = 1.78). No hubo diferencia en la presentación de efectos adversos (p = 0.642). Conclusiones: Tanto ketorolaco como metamizol demostraron un efecto comparable y pueden ser utilizados con seguridad.
BACKGROUND: Therapeutic pain is one of the most important outcome measures in surgery. Comparative studies investigating ketorolac efficiency in ambulatory surgery have generally been restricted to IV administration. We compared analgesic effectiveness of sublingual ketorolac and metamizole in short stay surgery. METHODS: This was a randomized single-blind clinical trial. All patients received either a three-dose (30 mg) of sublingual ketorolac or 1 g of IV metamizole, respectively. We evaluated pain with a visual/analog scale (VAS). Side effects were also recorded. Statistical analysis included t-test or Mann-Whitney U test and Fisher exact test or chi(2). Absolute risk reduction (ARR), odds ratio (OR), confidence interval (CI), relative risk ratio (RRR) and numbers needed to treat (NNT) were also evaluated. RESULTS: Rescue doses of analgesics were greater in patients receiving metamizole although the difference was not significant (p = 0.286). Mean VAS score was lower in the ketorolac group at 8 h after surgery, with no statistical difference (p = 0.06). ARR for severe pain score was almost 5% (OR = 1.78). Adverse effects did not show differences between groups (p = 0.642). CONCLUSIONS: Ketorolac and metamizole have comparable effects and can be safely used in ambulatory settings.