Efficacy and safety of local infiltration analgesia for pain management in total knee and hip arthroplasty

Abstract

Background: Local infiltration analgesia (LIA) has become popular in postoperative pain relief after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The aim of this meta-analysis was to compare the efficacy and safety of LIA with intrathecal morphine and epidural analgesia after THA and TKA. Methods: A systematic article search was performed from PubMed, Embase, and Web of Science databases, up to February 21, 2019. The main outcomes included visual analog scale for assessment of pain, morphine equivalent consumption, length of hospital stay, and adverse events. The data were calculated using weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (95% CIs). Results: Eleven studies with a total of 707 patients met the inclusion criteria and were included in this meta-analysis. LIA provided better pain control than other 2 techniques at 24-hour (WMD = 10.61, 95% CI: 3.36–17.87; P = .004), 48-hour (WMD = 16.0, 95% CI: 8.87–23.13; P < .001), and 72-hour (WMD = 11.31, 95% CI: 3.78–18.83; P < .001). Moreover, LIA had similar morphine consumption and duration of hospital stay with intrathecal morphine and epidural analgesia. There was significantly lower incidence of adverse events with LIA than with the other 2 techniques. Conclusion: LIA provided better postoperative pain control and less adverse events than intrathecal morphine and epidural analgesia after THA and TKA.

Efficacy of local infiltration analgesia on recovery after total hip arthroplasty using direct anterior approach under spinal anaesthesia: a randomized, double-blind, placebo-controlled trial

“…In order to confirm Kerr and Kohan's findings, several studies have been executed. Conflicting evidence has been reported [2][3][4][5][6]8,9,11,12,[14][15][16][17][18][19] . However, consulting and summarizing the literature to date, The Enhanced Recovery consumption of piritramide or tramadol, but an analysis of binary results whether the patients had taken opioids at all.…”

Postoperative Pain Control by Local Infiltration Analgesia and Peripheral Nerve Block in Primary Prosthetic Total Knee Arthroplasty

“… 37 Also in line with previous studies, we showed a mutually indistinguishable effect of LIA and FSNB 24 hours after surgery, 38 which was superior to the effects of post-op epidural opioids and intrathecal analgesics. 39 , 40 Since the systemic toxicity of LIA can affect up to 11% of patients, the post-op monitoring of LIA patients cannot be ignored. 41 A similar observation was made by Tian et al; their retrospective TKA study showed that the short-term analgesic effect of LIA was similar to that of nerve block and reduced the need for opiate supplementation, and that LIA and nerve block had similar complication rates.…”

Fast-Track-Endoprothetik

“…Es werden lokal und oral wirksame Analgetika eingesetzt – unter Berücksichtigung der Nebenwirkungsprofile eingesetzter Pharmazeutika, insbesondere auch der Opioide, die zurückhaltend eingesetzt werden sollten. Der Einsatz einer lokalen Infiltrationsanalgesie (LIA) in Kombination mit oralen Analgetika wird in der Knieendoprothetik favorisiert und ist auch an der Hüfte weit verbreitet [ 3 , 14 , 16 , 34 , 38 , 41 , 47 ]. Es wurden eine Reduktion des postoperativen Schmerzes, eine Verbesserung der Funktion sowie eine Reduktion der Dauer des Krankenhausaufenthaltes beschrieben [ 4 , 14 , 36 , 44 ].…”

“…Im Rahmen von Fast-Track-Konzepten wird in aller Regel gänzlich auf die Einlage von Wunddrainagen verzichtet, da diese die Beweglichkeit und selbstständige Mobilisation der Patienten beeinträchtigen sowie Schmerzen verursachen können, ohne einen Effekt auf das Auftreten postoperativer Wundinfektionen, die Häufigkeit von Wundverbandwechseln, Schwellung, postoperative Schmerzen oder die Rate thrombembolischer Ereignisse zu haben [ 50 ]. Zudem lässt sich durch den Verzicht eine Senkung der Transfusionsrate erzielen [ 37 , 38 ]. Ergänzend können moderne transparente und wasserdichte Pflasterverbände verwendet werden, die die sonst häufiger notwendigen Verbandswechsel überflüssig machen und das Risiko einer Wundkontamination mindern.…”