Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

Li, Chen; Qu, Jing; S, Pan; Qu, Yang

doi:10.1186/s13018-018-0770-9

Cited by 36 publications

(41 citation statements)

References 26 publications

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“…33 It comes as no surprise that patients undergoing same day discharge have reported excellent patient satisfaction when participating in a comprehensive OP total joint program that utilizes careful patient selection, refined surgical techniques, modern anesthesia protocols (including selective nerve blocks), and multimodal pain management regimens that limit the reliance on narcotic medications. 12,[34][35][36][37] The literature is largely in agreement supporting that OP TKA can be safely performed. Prospective studies are needed to better delineate the ideal candidate for OP TKA.…”

Section: Outcomes Of Outpatient Tkamentioning

confidence: 83%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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The rise of improved perioperative recovery protocols after total knee arthroplasty (TKA) has led to faster, more streamlined hospital stays for many patients. Combined with the implementation of value-based care and bundled payment initiatives, there has been a paradigm shift toward outpatient TKA surgery. This change to practice has been accelerated by recent policy changes enacted by the Center for Medicaid and Medicare Services regarding the removal of TKA as an inpatient only procedure as well as some insurance companies denying preauthorization for inpatient stays after TKA. Our review aims to address the inclusion and exclusion criteria for outpatient TKA consideration, examine the outcomes for outpatient joint replacement surgery, and discuss limitations of widespread adoption for same-day discharges.

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Section: Outcomes Of Outpatient Tkamentioning

confidence: 83%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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“…A meta‐analysis by Li et al . (2018) of seven RCT, with 251 patients undergoing TKA, concluded that LIA was as effective as epidural anesthesia for pain control. LIA showed an increase in the range of motion, and a reduction of the occurrence of nausea and length of hospital stay.…”

Section: Postoperative Analgesic Regimensmentioning

confidence: 99%

“…(2018) of seven RCT, with 251 patients undergoing TKA, concluded that LIA was as effective as epidural anesthesia for pain control. LIA showed an increase in the range of motion, and a reduction of the occurrence of nausea and length of hospital stay. Another meta‐analysis compared analgesic efficacy and side effect profile of FNB and epidural anesthesia through analyzing eight RCT with 510 patients.…”

Section: Postoperative Analgesic Regimensmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

218

165

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Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and retention of urine, which limit their application in daily clinical practice. The aim of this review was to discuss the current postoperative pain management regimens for TKA. Our review of the literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications and delivery routes, including preemptive analgesia, neuraxial anesthesia, peripheral nerve blockade, patient‐controlled analgesia and local infiltration analgesia, and oral opioid/nonopioid medications. Multimodal analgesia provides superior pain relief, promotes recovery of the knee, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

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“…Several methods have been applied to reduce postoperative pain after TKR including the peripheral nerve block and the local infiltration anesthesia, intravenous analgesics as well as the epidural anesthesia. [ 10 – 13 ] The optimal method remains under debate. Femoral nerve block (FNB) was reported to reduce postoperative pain and has increased in popularity because of its opioid sparing effects, and consistency with anticoagulatory therapy.…”

Section: Introductionmentioning

confidence: 99%

Femoral nerve block versus obturator nerve block for pain management after total knee replacement

Zhang

Lin²,

Zhang³

et al. 2020

Medicine

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Background: Several studies reported short-term analgesic efficacy of obturator nerve block (ONB), as in comparison with the femoral nerve block (FNB) in the treatment of postoperative pain after the total knee replacement (TKR). The optimal method remains under debate. The purpose of our current work is to compare the safety and efficacy of FNB and ONB for postoperative analgesia after TKR. Methods: This prospective, randomized, and controlled study was performed from January 2018 to December 2019. It was authorized via the Institutional Review Committee in NO.971 Hospital of the People's Liberation Army Navy (2019-PLAN-132). Two hundred patients were divided randomly into 2 groups, the control group (n = 100) and study group (n = 100). The experimental group received FNB and control groups received ONB. Primary outcome included pain at different time point (Visual Analogue Scale score of anterior knee pain at rest and in motion). The Visual Analogue Scale scores were marked by patients themselves on a paper with a graduated line starting at 0 (no pain) and ending at 10 (the most painful). Opioid consumption was converted to equivalents of oral morphine uniformly for statistical analysis. Secondary outcomes included the knee range of motion, the hospital stay length as well as the postoperative complications such as pulmonary embolism and deep vein thrombosis. Results: Table 1 will show the clinical outcomes between the 2 groups. Conclusion: This trial would provide an evidence for the use of different types of peripheral nerve blocks in TKR.

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Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

Cited by 36 publications

References 26 publications

Inpatient versus Outpatient Total Knee Arthroplasty

Inpatient versus Outpatient Total Knee Arthroplasty

Postoperative Pain Management in Total Knee Arthroplasty

Femoral nerve block versus obturator nerve block for pain management after total knee replacement

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