Intra-articular bupivacaine after joint arthroplasty: a systematic review and meta-analysis of randomised placebo-controlled studies

Abstract

ObjectivesTo evaluate the efficacy and safety of intra-articular (IA) bupivacaine administered for pain relief after joint arthroplasty.DesignMeta-analysis.MethodsA systematic review was conducted to identify the randomised controlled trials using IA bupivacaine for postoperative pain relief from MEDLINE, Cochrane Library and EMBASE databases (up to October 2015). The standardised mean difference (SMD), the relative risk (RR) and their corresponding 95% CIs were calculated using the RevMan statistical software.ResultsA total of 11 randomised controlled trials were included. Statistically significant differences between IA bupivacaine and placebo were observed for the mean visual analogue scale (VAS) values (SMD −0.55; 95% CI −0.89 to −0.22; p<0.001) and narcotic consumption (SMD −0.32; 95% CI −0.55 to −0.08; p=0.008) during the period of 24 hours postoperatively and narcotic consumption during the period between 24 and 48 hours postoperatively (SMD −0.32; 95% CI −0.55 to −0.08; p=0.009). However, there was no significant difference in the mean VAS pain score during the period between 24 and 48 hours postoperatively (SMD −0.09, 95% CI −0.30 to 0.11; p=0.37) and in the incidence of adverse effects 24–72 hours postoperatively (RR 0.97; 95% CI 0.60 to 1.57; p=0.91).ConclusionsThe administration of IA bupivacaine after joint arthroplasty is effective for pain relief without increasing adverse effects.

Comparison of the pericapsular nerve group block with the intra-articular and quadratus lumborum blocks in primary total hip arthroplasty: a randomized controlled trial

“…As demonstrated in previous studies, administration of the PENG block [ 16 ], QLB [ 10 ], or IA injection [ 12 , 13 ] alone contributes to a reduction in postoperative pain scores and opioid consumption in patients undergoing THA. To the best of our knowledge, however, this is the first randomized controlled study to compare these three techniques.…”

“…Intra-articular (IA) local anesthetic injections, which are practical and easy to administer, have been reported to result in lower postoperative pain scores and opioid compared to non-administered group in previous studies on hip arthroplasty [ 12 , 13 ].…”

Motor-sparing peripheral nerve blocks for hip and knee surgery

“…Several neuraxial, peripheral nerve block, and locoregional techniques have been described for total hip arthroplasty (THA) and hip fracture pain management, including epidural analgesia, lumbar and sacral plexus blocks, intrathecal opioid administration, and periarticular infiltration (PAI) or local infiltration analgesia (LIA) [2,4,5]. The decision for any individual or combination of these techniques is guided by both benefits and potential risks for complications in individual patients.…”

Analgesic efficacy of single-shot adductor canal block versus adductor canal block combined with intra-articular ropivacaine infusion after total knee arthroplasty

“…Pain management strategies have evolved from systemic opioids to epidural anaesthesia to peripheral nerve blockade, trending towards a more local approach which has shown promising results. 1 - 3 Multimodal analgesia has been shown to be superior to monotherapy, subsequently reducing opiate use after surgery.…”

“…These include less toxicity and early mobilization. 2 , 3 Problems with epidural anaesthesia are mainly related to delayed rehabilitation, and bladder and bowel problems. 4 There have been reports of quadriceps weakness with femoral nerve block, leading to delayed mobilization.…”