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

doi:10.3969/j.issn.2095-4344.3854

Abstract

Abstract: OBJECTIVE: Local infiltration anesthesia and femoral nerve block are very prevalent anesthesia methods after total knee arthroplasty. However, which one was optimal in pain control was still controversial. The difference of components in local infiltration anesthesia led to great bias in outcomes, which may be one reason for the inconsistent results in the past. We took a systematic review to compare the efficacy and safety of femoral nerve block with the local infiltration anesthesia that use the fixed drug compositions (local anesthetics + nonsteroid anti-inflammatory drugs + epinephrines) for total knee arthroplasty.
METHODS: Randomized controlled trials concerning local infiltration anesthesia and femoral nerve block on pain control after total knee arthroplasty from PubMed, Embase, Cochrane Library, Web of Science and Viod were searched until June 30, 2020 by using the following terms “total knee arthroplasty, local infiltration analgesia, periarticular infiltration, femoral nerve block”. The quality of the included study was assessed using the Cochrane risk of bias table. The data were analyzed by RevMan 5.3 software for meta-analysis. The evaluation indexes contained main pain outcomes, secondary functional outcomes, and complications.
RESULTS: (1) A total of 9 studies including 514 patients were included, all of which were randomized controlled trials. The literature quality evaluation indicated that the quality of the included literatures was relatively high. (2) The pooled data indicated that there was no significant difference in visual analogue scale score at 24 hours on rest, 48 hours on rest, 24 hours on motion and 48 hours on motion, opioid consumption at 48 hours, range of motion at 24 and 48 hours, length of hospital stay, 6-minute walk test at 6 weeks, rate of infection and rate of nausea and vomiting between two groups (P > 0.05). However, the local infiltration anesthesia consumed significantly less opioid than femoral nerve block at 24 hours (MD=-4.09, 95%CI:-6.10 to -2.08, P < 0.000 1).
CONCLUSION: Local infiltration anesthesia with the fixed compositions was superior to femoral nerve block in pain control of acute phase after total knee arthroplasty, and there was no significant difference in knee function recovery and complications. Considering that local infiltration anesthesia was easier to operate and less expensive, we recommended local infiltration anesthesia as the optimal pain management after total knee arthroplasty.

Key words: knee, joint, knee joint, pain control, total knee arthroplasty, anesthesia, cocktail, femoral nerve block, meta-analysis

CLC Number:

Deng Zhibo, Li Zhi, Wu Yahong, Mu Yuan, Mu Yuexi, Yin Liangjun. Local infiltration anesthesia versus femoral nerve block for pain control and safety after total knee arthroplasty: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(21): 3401-3408.

Figures/Tables 16

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