Efeito aditivo da compressão à crioterapia na dor, edema e no consumo de medicamentos em sujeitos pós cirurgias de joelho: uma revisão sistemática com metanálise

Abstract

Contextualization: Knee surgeries lead to tissue repair processes that culminate in pain, edema and higher medicine consumption. To alleviate these repercussions, it is recommended to use cryotherapy, a non-pharmacological resource with positive effects on intra-articular temperature control, inflammatory control and premature restoration of muscle strength. Local compression can be added to cryotherapy by expanding the therapeutic potential of this conduct. Although this combination is widely practiced, scientific evidence is not conclusive regarding the therapeutic superiority of the associated use of cryotherapy and compression compared to cryotherapy alone. Objective: To verify that compression has an additive effect to cryotherapy on pain, edema and drug consumption in individuals who underwent knee surgery. Materials and methods: A systematic review of randomized clinical trials (RCT) with meta-analysis that compared cold compression with isolated cryotherapy in pain, edema and consumption of drugs after knee surgeries. The

review followed the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines, with protocol registered in PROSPERO, No.

CRD42022321200. The search for major databases was based on the PICO strategy by independent researchers. Meta -analysis was performed with the aid of the Review Manager - Revman 5.4 software for outcomes in the first and second week of postoperative (P.O.) and the average differences with 95% confidence intervals are calculated. Results: Five RCTs were selected that met the inclusion criteria, with 267 individuals (male: 156, female: 111) and the age ranging from 24.2 to 71.7 years. Meta-analysis has shown no additional benefits of compression when associated with isolated cryotherapy in pain in the first week (average difference (MD) -0.71 (95%CI: -1.68 to 0.26; p <0.15), in pain in the second week: (MD: 0.13, CI: 95%: -057 to 0.31; p <0.57) and edema in the first week (MD: -0.32, (IC: 95%, -0.89 and 0.25; p <0.27). Discussion: This meta-analysis has found no difference in short-term pain and edema. It is not possible to state that cold-compression is superior to isolated cryotherapy. Despite the questionable methodological quality of the 5 RCTs, the results are similar like those of Song et al. (2016). Data from other systematic

reviews are insufficient to determine a consistent way on the superiority of cold- compression on isolated cryotherapy. Furthermore, Cold-Compression devices are of

high costs compared to isolated cryotherapy. Conclusion: This review directs to knowledge gaps that need to be supplied so that there is robust clinical evidence of duality between cold-compression x isolated cryotherapy. Based on these findings, additional costs and resources must be taken into consideration, and it is not possible to determine which modality is clinically superior.