Published: 2022-12-02

Post-operative management of inflammation after orthopaedic surgeries using trypsin, bromelain and rutoside combination: a single-centre prospective observational study

Yogesh Sisodia, Ramprasad Dharangutti, Bhushan M. Khemnar, James John, Deepakkumar T. Vishwakarma


Background: Post-operative management of inflammation plays an important role in orthopaedic surgeries, as delay in wound healing may lead to extended hospital stay. Proteases like trypsin and bromelain combined with the bioflavonoid rutoside are often used to reduce post-operative pain and swelling. The present study aimed to evaluate the efficacy and safety of oral administration of a fixed dose combination of trypsin-bromelain-rutoside in the post-operative management after orthopaedic surgeries.

Methods: The study was a prospective, observational data collection exercise. Hundred subjects undergoing orthopaedic surgeries, who were administered trypsin-bromelain-rutoside combination, were observed over a period of 8 days post-surgery. Verbal rating scales were used for grading the pain intensity and extent of swelling, while a 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling. Scores at day 3 and day 8 were analysed using paired t test.

Results: At day 3 and day 8, the mean scores of pain and swelling were significantly reduced from baseline (all p<0.0001). By day 8, 74% of the patients achieved complete resolution of pain, while 50% reported complete resolution of swelling. By day 8, 54% patients reported excellent/ very good global improvement in pain and swelling, while the investigator reported excellent/ very good global improvement in 81% of the patients. No adverse event was reported in any of the patients.

Conclusions: The combination of trypsin-bromelain-rutoside was safe and effective in reducing the post-operative pain and swelling after orthopaedic surgeries. An 8-day treatment led to complete resolution of pain in three-fourths of the patients and complete resolution of swelling in half the patients. The use of this combination has the potential to reduce hospital stay and pill burden.


Orthopaedic surgery, Enzymes, Inflammation, Pain, Swelling

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