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DOCUMENTSInfluence of Simultaneous Local Anesthesia on the Clinical Outcome after Repetitve Low-Energy Shock Wave Therapy for Chronic Te
Author
HANG SANG
Date
2020-01-07 23:30
Views
489
Abstract
Background: The efficacy of shock wave therapy is discussed controversially. It is unclear whether the simultaneous application of local anesthesia interferes with clinical outcome.
Methods: The presenting department had treated 51 patients with a chronic lateral epicondylitis in the frame of a randomized single-blind multicenteric trial with a parallel-group design and blinded independent observer to evaluate low-energy Extracorporeal Shock Wave Therapy (ESWT; 3 x 2000 pulses, energy flux density ED+ 0.09 mJ/mm2) in combination with local anesthesia versus placebo ESWT in combination with local anesthesia for patients with a chronic tennis elbow. Primary outcome measure of the multicenter trial was the number of good or excellent results according to the score of Roles and Maudsley at three-month follow-up. At this point of time only three of 28 patients (11%) of the verum group and four of 20 patients of the placebo group (25%) treated in the frame of the multicenter trial by the presenting center achieved an excellent or good outcome according to the score of Roles and Maudsley (primary outcome measure).
Patients not satisfied with their outcome formed the basis of the presented study. After having been unblinded, unsatisfied patients of the verum group were offered once again application of the identical active treatment concept, this time without local anesthesia, while unsatisfied patients of the placebo group were offered cross-over therapy, i.e. identical active treatment with local anesthesia. Again, the primary outcome measure was the number of good or excellent results according to the score of Roles and Maudsley at three-month follow-up.
Results: Fifteen of 28 patients of the original verum group decided to have ESWT without local anesthesia. Fifteen of 20 patients of the original placebo group decided to have cross-over therapy, i.e. ESWT with local anesthesia. Reception of active therapy without local anesthesia resulted in excellent or good outcomes in 12 of 15 patients (80%) followed of the original verum group at three-month follow-up, while application of active therapy with local anesthesia lead to good outcomes in four of 15 patients (27%) of the original placebo group after three months (p= 0.0092 for difference between groups).
Conclusion: At three months success rates after low-energy ESWT with local anesthesia were significantly lower than after low-energy ESWT without local anesthesia. The difference persisted at twelve-month follow-up. Further randomized studies are necessary to clarify the negative influence of simultaneous local anesthesia on the outcome of repetitive low-energy ESWT for chronic tennis elbow.
Background: The efficacy of shock wave therapy is discussed controversially. It is unclear whether the simultaneous application of local anesthesia interferes with clinical outcome.
Methods: The presenting department had treated 51 patients with a chronic lateral epicondylitis in the frame of a randomized single-blind multicenter
Patients not satisfied with their outcome formed the basis of the presented study. After having been unblinded, unsatisfied patients of the verum group were offered once again application of the identical active treatment concept, this time without local anesthesia, while unsatisfied patients of the placebo group were offered cross-over therapy, i.e. identical active treatment with local anesthesia. Again, the primary outcome measure was the number of good or excellent results according to the score of Roles and Maudsley at three-month follow-up.
Results: Fifteen of 28 patients of the original verum group decided to have ESWT without local anesthesia. Fifteen of 20 patients of the original placebo group decided to have cross-over therapy, i.e. ESWT with local anesthesia. Reception of active therapy without local anesthesia resulted in excellent or good outcomes in 12 of 15 patients (80%) followed of the original verum group at three-month follow-up, while application of active therapy with local anesthesia lead to good outcomes in four of 15 patients (27%) of the original placebo group after three months (p= 0.0092 for difference between groups).
Conclusion: At three months success rates after low-energy ESWT with local anesthesia were significantly lower than after low-energy ESWT without local anesthesia. The difference persisted at twelve-month follow-up. Further randomized studies are necessary to clarify the negative influence of simultaneous local anesthesia on the outcome of repetitive low-energy ESWT for chronic tennis elbow.