Compression
Limited evidence suggests no significant differences in pain or function with compression.
Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery (2021)
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: SOMOS, OTA

Rationale

The Compression recommendation has been downgraded two levels because of inconsistent evidence.

Three high quality studies (Grubhofer 2018, Snyder 2017, Pornrattanamaneewong 2019) and two moderate quality (Windisch 2011, Pornrattanamaneewong 2018) were evaluated with inconsistent results.  In most cases, compression versus standard care showed no significant differences for pain or function.  In one study, prolonged use of compression for six weeks had improved VAS and decreased DVT rate.  A separate study had decreased opioid use on post-operative day one with compression.

Benefits/Harms of Implementation

Overall, effect size is limited with these studies, however the low cost and risk to the patient of compression weigh positively in considering use of this physical treatment.  A decreased rate of DVT could have a benefit to the patient.

Cost Effectiveness/Resource Utilization

Use of compression in these studies required a specific machine which itself would be a large cost if a treating facility had not already invested in these devices.  Otherwise, resource utilization is low.

Acceptability

Compression is already widely used in hospitals and would have no concerns with acceptability.

Feasibility

Compression is already widely used in hospitals and would have no concerns with feasibility.  For an extended use of compression (after discharge), feasibility would be more challenging to gain resources from payers to distribute portable devices.

Future Research

Increased studies with larger patient populations evaluating compression with better examination of pain and opioid consumption after these interventions, better examination of functional scores and outcomes after this intervention.