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. 2023 Jul 24;10(1):72.
doi: 10.1186/s40634-023-00639-3.

Dynamic intermittent compression cryotherapy with intravenous nefopam results in faster pain recovery than static compression cryotherapy with oral nefopam: post-anterior cruciate ligament reconstruction

Mohamad K Moussa  1 , Nicolas Lefevre  2 , Eugenie Valentin  2 , Alain Meyer  2 , Olivier Grimaud  2 , Yoan Bohu  2 , Antoinne Gerometta  2 , Frederic Khiami  2 , Alexandre Hardy  2
Affiliations

Dynamic intermittent compression cryotherapy with intravenous nefopam results in faster pain recovery than static compression cryotherapy with oral nefopam: post-anterior cruciate ligament reconstruction

Mohamad K Moussa et al. J Exp Orthop. .

Abstract

Purpose: To evaluate the effectiveness of dynamic intermittent compression cryotherapy (DICC) (CryoNov®) with an intravenous nefopam-based pain management protocol (DCIVNPP) in reducing post-operative pain following anterior cruciate ligament reconstruction (ACLR) compared to static compression cryotherapy (SCC) (Igloo®) and oral Nefopam.

Methods: This was a retrospective analysis of prospectively collected data including 676 patients who underwent primary ACLR in 2022. Patients were either in the DCIVNPP group or in the SCC (control group), and were matched for age, sex, and Lysholm and Tegner scores (338 per arm). The primary outcome was pain on the visual analogue scale (VAS), analyzed in relation to the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) thresholds for VAS. The secondary outcome was side effects.

Results: Postoperative pain in the DCIVNPP group was less severe on the VAS than in the control group (p < 0.05). The maximum difference in the VAS between groups was 0.57, which is less than the MCID threshold for VAS. The DCIVNPP group crossed the PASS threshold for VAS on Day 3, sooner than the control group. The side effect profiles were similar in both groups except for higher rates of dizziness and malaise in the DCIVNPP group, and higher rates of abdominal pain in the control group. Most of the side effects decreased over time in both groups, with no significant side effects after Day 3.

Conclusion: DCIVNPP effectively allows for faster pain recovery than in the control group. The difference in side effects between the protocols may be due to mode of administration of nefopam.

Level of evidence: III.

Keywords: ACL reconstruction; Cryotherapy; Dynamic compression cryotherapy; Early recovery; Morphine-free analgesia; PASS; Static cryotherapy.

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Conflict of interest statement

NL: Consultant at Websurvey Society, Paris France.

AH: Consultant for Arthrex and Depuy.

Figures

Fig. 1
Fig. 1
Flow chart of the study design
See this image and copyright information in PMC

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