Comparing the efficacy of pain managements after total hip arthroplasty: A network meta‐analysis

Abstract

The aim of our current study is to compare efficiency of various interventions implemented for pain management after total hip arthroplasty (THA). PubMed and EMBASE were searched for randomized clinical trials (RCTs) reporting the pain scales for evaluate the efficacy of pain control after THA including at least one pair of direct control groups. Pain scale values and the associated 95% credible interval (CrI) were used to describe efficacy. Surface under the cumulative ranking curve (SUCRA) of each means of pain control was calculated to compare the relative ranking of different interventions. Thirty-five eligible literatures were involved in data analysis. The interventions for postoperative pain management we examined were psoas compartment block (PCB), posterior nerve block (PNB), fascia iliaca block (FIB), periarticular injection (PAI), femoral nerve block (FNB), lumbar plexus block (LPB), spinal anesthesia (SA), epidural analgesia (EPI), intrathecal morphine (IA), intravenous patient-controlled analgesia (IV-PCA), patient-controlled analgesia (PCA), onsteroidal anti-inflammatory drug (NSAID), local infiltration analgaesia (LIA), and reverse LIA (rLIA). In 0 to 6 hours analysis, patients under SA were found to have significantly lower pain score and SA was ranked the best.In 6 to 12 hours analysis, SA was found to be significantly more effective than other interventions and its SUCRA was the highest. No intervention showed a significant effect on reducing pain score for 12 to 24 hours and 24 to 48 hours after THA. SA is the best intervention to reduce THA postoperative pain in the first 24 hours. LPB is a better choice to reduce pain 12 to 48 hours after THA. K E Y W O R D S analgesia, anesthesia, network meta-analysis, postoperative pain management, THA J Cell Biochem. 2019;120:4342-4354. wileyonlinelibrary.com/journal/jcb 4342 |

Enhanced recovery principles applied to revision hip and knee arthroplasty leads to better patient outcomes

“…20 Other Anaesthetic related interventions in this latest cohort include the increased use of low-volume single shot spinal anaesthetic of morphine and heavy bupivicaine and sedation peri-operatively, with only 6 patients needing a general anaesthetic since 2015, compared to 19 patients from 2010 to 2014.1 A meta-analysis by Liu et al found spinal anaesthetic the best form of analgesia post-operatively for patients undergoing total hip arthroplasty; the most effective time period for this being 6-12 h post-operatively. 21 Another significant finding in this study involves the use of intraarticular catheters for analgesia administration post-operatively in rTKA. In our original study, we could not show any reduction in PCA use in this patient cohort.…”

The efficacy of fascia iliaca compartment block for pain control after hip fracture

“…Results shown that, FICB is an effective and safe method for alleviating the pain in lower limb surgery. Liu et al [24] conducted a network meta-analysis and also found that FICB was superior than placebo in hip arthroplasty patients. We performed a subgroup analysis for VAS at 1–8 h, results shown that FICB has a beneficial role in reducing pain scores at 1–8 h at any subgroup (operative technique, risk of bias, volume, and anesthesia).…”

Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

“…Alternative pain management strategies after PAO are EA and LIA. EA is known to provide reliable pain relief after surgery of the lower limbs [12,18]. Despite the routine clinical use of EA in PAO patients, there are no studies regarding the clinical efficacy of this practice [10].…”