Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block

Abstract

Patients frequently experience postoperative pain after a total knee arthroplasty; such pain is always challenging to treat and may delay the patient's recovery. It is unclear whether local infiltration or a femoral nerve block offers a better analgesic effect after total knee arthroplasty.We performed a systematic review and meta-analysis of randomized controlled trials to compare local infiltration with a femoral nerve block in patients who underwent a primary unilateral total knee arthroplasty. We searched Pubmed, EMBASE, and the Cochrane Library through December 2014. Two reviewers scanned abstracts and extracted data. The data collected included numeric rating scale values for pain at rest and pain upon movement and opioid consumption in the first 24 hours. Mean differences with 95% confidence intervals were calculated for each end point. A sensitivity analysis was conducted to evaluate potential sources of heterogeneity.While the numeric rating scale values for pain upon movement (MD-0.62; 95%CI: -1.13 to -0.12; p=0.02) in the first 24 hours differed significantly between the patients who received local infiltration and those who received a femoral nerve block, there were no differences in the numeric rating scale results for pain at rest (MD-0.42; 95%CI:-1.32 to 0.47; p=0.35) or opioid consumption (MD 2.92; 95%CI:-1.32 to 7.16; p=0.18) in the first 24 hours.Local infiltration and femoral nerve block showed no significant differences in pain intensity at rest or opioid consumption after total knee arthroplasty, but the femoral nerve block was associated with reduced pain upon movement.

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“…Although postoperative VAS scores of the two groups were similar for the first 12 hours after the surgery, VAS score at rest was significantly lower (p = 0.019) for the FNB group than the LIA group between 12-23 hours which is similar to the findings of other studies [12,13]. There were differences in the incidences of postoperative nausea and vomiting.…”

“…According to a meta-analysis by Mei et al, both LIA and FNB analgesic regimes for TKA are effective in reducing the pain and use of opioids [12]. Carli et al observed that the continuous FNB method reduced opioid consumption and improved recovery at 6 weeks more than periarticular infiltration analgesia [25].…”

A Randomised Controlled Trial of Local Infiltration Analgesia Versus Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty

“…Following the completion of our trial, several studies and meta-analyses have since been published comparing LIA with FNB [11][12][13][14][15][16][17][18]. Our trial supported many of the findings of these studies, including the lack of differences in postoperative pain scores, rates of complication, and length of hospital stay.…”

Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review

“…Two MAs compare PNB to epidural analgesia after TKA [22, 25]. The literature additionally includes 20 MAs [1, 3, 17, 21, 24, 27, 36, 40, 50, 54–56, 60, 61, 70, 77, 98, 99, 109, 112], three SRs [4, 10, 104], and three large-scale observational studies [23, 69, 72] of combinations of PNBs and local-anesthetic infiltration techniques for analgesia and opioid-sparing capacity after TKA. Compared to placebo (or no-block), all PNBs studied provide superior analgesia and reduce IV patient-controlled analgesia (PCA), opioid consumption, and opioid-related adverse effects [1, 10, 27, 77, 104].…”