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

Детали доказательств RCTСсылка на исследование

GRADE НизкаяКогортное исследование / серия случаев

Характеристика исследования

Дизайн: single-center, open-label, randomized controlled trial (Cairo)
Размер выборки (n): 60
Вмешательство: Single session of 3-4 Hirudo medicinalis leeches at the postoperative knee, applied 24 hours post-arthroscopy
Компаратор: Standard analgesia: oral diclofenac 75mg twice daily + cold pack for 5 days
Первичная конечная точка: Pain on 100mm VAS at day 5
Основной результат: 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
Длительность наблюдения: 4 weeks

Ключевые выводы

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

Ограничения

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

Клиническое значение

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.

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