Leech therapy for postoperative pain and swelling after knee arthroscopy: a randomized controlled trial
Bishaw AM, El-Sayed M, Hassan H, Ibrahim M (2020) · Egyptian Rheumatology and Rehabilitation · n=60
RCT-EvidenzdetailsStudienreferenz
GRADE NiedrigKohorte / Fallserie
Studienprofil
- Design
- single-center, open-label, randomized controlled trial (Cairo)
- Stichprobengröße (n)
- 60
- Intervention
- Single session of 3-4 Hirudo medicinalis leeches at the postoperative knee, applied 24 hours post-arthroscopy
- Komparator
- Standard analgesia: oral diclofenac 75mg twice daily + cold pack for 5 days
- Primärer Endpunkt
- Pain on 100mm VAS at day 5
- Primäres Ergebnis
- VAS pain reduction 36.4mm in leech vs 22.8mm in standard care at day 5 (between-group difference 13.6mm, p=0.008); knee circumference (swelling) decreased 1.8cm vs 0.7cm
- Effect size (Cohen's d)
- 0.69
- Follow-up-Dauer
- 4 weeks
Wichtigste Ergebnisse
- First RCT of leech therapy in immediate postoperative period after orthopedic surgery
- Significant reduction in both pain and objectively measured knee swelling
- Lower opioid rescue use in leech arm (1.4 vs 3.2 doses over 5 days)
- Earlier return to weight-bearing in leech arm (day 3.2 vs day 4.8)
- No surgical-site infections in either arm
Einschränkungen
- Single center, Egypt
- Open-label
- Excluded patients on chronic anticoagulation
- 4-week follow-up too short to address late outcomes (rehabilitation, return to sport)
- Variable arthroscopic procedures (meniscectomy, ACL, microfracture) — heterogeneous primary surgery
Klinische Implikationen
Bishaw 2020 is the only RCT for hirudotherapy in the immediate postoperative orthopedic setting. The pain and swelling reductions plus lower opioid rescue use are clinically meaningful given the current opioid-sparing imperative. For orthopedic centers willing to manage the operational complexity (leech storage, biohazard handling) in a postoperative ward, this trial supports adjunctive use after knee arthroscopy.