Local infiltration analgesia and femoral nerve block for pain control after total knee arthroplasty: a meta-analysis

doi:10.3969/j.issn.2095-4344.2016.39.020

Abstract

Abstract:

BACKGROUND: Both local infiltration analgesia and femoral nerve block are used for the pain management after total knee arthroplasty. Controversy still remains regarding the optimal technique for pain relief.

OBJECTIVE: To systematically evaluate analgesic effects of local infiltration analgesia and femoral nerve block after total knee arthroplasty.

METHODS: Databases including PubMed, EMBASE, the Cochrane Library, Web of Science and CBM, were comprehensively searched to identify randomized controlled studies comparing local infiltration analgesia with femoral nerve block. Two reviewers independently selected trials, included literatures, extracted data, and assessed the methodological qualities of included studies according to Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. When there were different opinions, it was decided by the third author. Data were analyzed by RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 566 patients were included. (2) At 24 and 48 hours (h) after surgery, there were no significant differences between the local infiltration analgesia and femoral nerve block groups, in Visual Analog Scale scores [MD_{24 h}=0.15, 95%CI (-0.26, 1.28), P > 0.05; MD_{48 h}=0.19, 95%CI (-0.06, 0.44), P > 0.05] in the resting state, and [MD_{24 h}=-0.01, 95%CI (-0.51, 0.48), P > 0.05; MD_48h=0.18, 95%CI (-0.45, 0.82), P > 0.05] in the active state, amount of analgesic drug use [MD_{24 h}=-2.23, 95%CI (-5.63, 1.16), P > 0.05; MD_{48 h}=2.44, 95%CI (-1.08, 5.95), P > 0.05], hospital stay [MD=0.05, 95%CI (-0.40, 0.50), P > 0.05], postoperative nausea and vomiting [OR=1.09, 95%CI (0.39, 3.04), P > 0.05] and postoperative infection [OR=0.99, 95%CI (0.44, 2.59), P > 0.05]. (3) These results indicated that the analgesic effect of local infiltration analgesia was identical to that of femoral nerve block after total knee arthroplasty. Due to its simple operation, local infiltration analgesia can be used as a standard analgesia method after total knee arthroplasty.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Knee, Femoral Nerve, Anesthesia, Pain

CLC Number:

R318

Xing Mei-li, Xu Bin, Xin Ying. Local infiltration analgesia and femoral nerve block for pain control after total knee arthroplasty: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2016, 20(39): 5904-5911.

Figures/Tables 5

References

[1] 苏杭, 杨春喜, 岳家吉. 全膝关节置换术围手术期的镇痛方法[J]. 中华关节外科杂志(电子版),2015, 9(3): 416-419.
[2] Berend ME, Berend KR, Lombardi AV Jr. Advances in pain management: game changers in knee arthroplasty. Bone Joint J. 2014;96-B(11 Supple A): 7-9.
[3] Chan EY, Fransen M, Parker DA, et al.Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014;5:CD009941.
[4] Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop. 2008;79(2):174-183.
[5] Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: http://www.cochranehandbook.org.
[6] Affas F, Nygards EB, Stiller CO, et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop, 2011;82(3):441-447.
[7] Ashraf A, Raut VV, Canty SJ, et al. Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block. Knee. 2013;20(5): 324-327.
[8] Carli F, Clemente A, Asenjo JF, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesthesia.2010; 105(2):185-195.
[9] Chaumeron A, Audy D, Drolet P, et al. Periarticular injection in knee arthroplasty improves quadriceps function. Clin Orthop Relat Res. 2013;471(7): 2284-2295.
[10] Kovalak E, Dogan AT, Uzumcugil O, et al. A comparison of continuous femoral nerve block and periarticular local infiltration analgesia in the management of early period pain developing after total knee arthroplasty Acta Orthop Traumatol Turc. 2015; 49(3):260-266.
[11] Kurosaka K, Tsukada S, Seino D, et al. Local infiltration analgesia versus continuous femoral nerve block in pain relief following total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2015.
[12] Moghtadaei M, Farahini H, Faiz SH-R, et al. Pain Management for Total Knee Arthroplasty: Single-Injection Femoral Nerve Block versus Local Infiltration Analgesia. Iran Red Crescent Med J. 2014; 16(1):E13247.
[13] Ng FY, Ng JK, Chiu KY, et al. Multimodal Periarticular Injection Vs Continuous Femoral Nerve Block After Total Knee Arthroplasty A Prospective, Crossover, Randomized Clinical Trial. J Arthroplasty. 2012;27(6): 1234-1238.
[14] Toftdahl K, Nikolajsen L, Haraldsted V, et al. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthopaedica. 2007; 78(2):172-179.
[15] 陈东风, 蒋建清. 股骨神经阻滞与局部浸润麻醉对全膝关节置换术后疼痛管理的疗效比较[J].中华全科医学, 2014, 12(11): 1867-1868.
[16] 冯常武, 卢杰, 丁一, 等. 连续股神经阻滞对全膝关节置换术的镇痛及恢复效果[J]. 现代生物医学进展, 2015, 15(25): 4905-4907.
[17] Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am. 2006;88(5):959-963.
[18] Jiang J, Teng Y, Fan Z, et al. The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J Arthroplasty. 2013;28(10):1882-1887.