Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia

Pandazi, Ageliki; Kanellopoulos, Ilias; Kalimeris, Konstantinos; Batistaki, Chrysanthi; Nikolakopoulos, Nikolaos; Matsota, Paraskevi; Babis, George C.; Kostopanagiotou, Georgia

doi:10.1007/s00402-013-1849-8

Cited by 37 publications

(28 citation statements)

References 22 publications

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“…Prior to submission, we updated searches in December 2013 and identified 12 new studies, three in patients with THR and nine in patients with TKR. Our results for local anaesthetic infiltration in patients receiving THR were supported with reduced pain compared with untreated control [69-71], or similar pain compared with epidural analgesia [71]. The results of our meta-analyses in patients receiving TKR were also supported with improved early pain control in patients receiving local anaesthetic infiltration [72]; further pain reduction with added ketoralac [73,74] but not steroid [75]; and uncertainty when compared with femoral nerve block [76-80].…”

Section: Discussionsupporting

confidence: 59%

Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness

Marques

Jones

Elvers

et al. 2014

BMC Musculoskelet Disord

105

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BackgroundSurgical pain is managed with multi-modal anaesthesia in total hip replacement (THR) and total knee replacement (TKR). It is unclear whether including local anaesthetic infiltration before wound closure provides additional pain control.MethodsWe performed a systematic review of randomised controlled trials of local anaesthetic infiltration in patients receiving THR or TKR. We searched MEDLINE, Embase and Cochrane CENTRAL to December 2012. Two reviewers screened abstracts, extracted data, and contacted authors for unpublished outcomes and data. Outcomes collected were post-operative pain at rest and during activity after 24 and 48 hours, opioid requirement, mobilisation, hospital stay and complications. When feasible, we estimated pooled treatment effects using random effects meta-analyses.ResultsIn 13 studies including 909 patients undergoing THR, patients receiving local anaesthetic infiltration experienced a greater reduction in pain at 24 hours at rest by standardised mean difference (SMD) -0.61 (95% CI -1.05, -0.16; p = 0.008) and by SMD -0.43 (95% CI -0.78 -0.09; p = 0.014) at 48 hours during activity.In TKR, diverse multi-modal regimens were reported. In 23 studies including 1439 patients undergoing TKR, local anaesthetic infiltration reduced pain on average by SMD -0.40 (95% CI -0.58, -0.22; p < 0.001) at 24 hours at rest and by SMD -0.27 (95% CI -0.50, -0.05; p = 0.018) at 48 hours during activity, compared with patients receiving no infiltration or placebo. There was evidence of a larger reduction in studies delivering additional local anaesthetic after wound closure. There was no evidence of pain control additional to that provided by femoral nerve block.Patients receiving local anaesthetic infiltration spent on average an estimated 0.83 (95% CI 1.54, 0.12; p = 0.022) and 0.87 (95% CI 1.62, 0.11; p = 0.025) fewer days in hospital after THR and TKR respectively, had reduced opioid consumption, earlier mobilisation, and lower incidence of vomiting.Few studies reported long-term outcomes.ConclusionsLocal anaesthetic infiltration is effective in reducing short-term pain and hospital stay in patients receiving THR and TKR. Studies should assess whether local anaesthetic infiltration can prevent long-term pain. Enhanced pain control with additional analgesia through a catheter should be weighed against a possible infection risk.

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Section: Discussionsupporting

confidence: 59%

Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness

Marques

Jones

Elvers

et al. 2014

BMC Musculoskelet Disord

105

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“…3). In addition to the RCTs included in the two pairwise meta-analyses, Bayesian network meta-analysis included 10 more RCTs [3,12,14,19,32,45,48,53,55,61] comparing use of local infiltration analgesia or peripheral nerve blocks with epidural analgesia or intrathecal morphine. By introducing the additional indirect comparisons (epidural analgesia, intrathecal morphine) we increased the power and precision of the network meta-analysis (Appendix 1.…”

Section: Discussionmentioning

confidence: 99%

“…We combined intervention arms in three studies: single-shot and continuous local infiltration analgesia [54]; continuous lumbar plexus block and continuous femoral nerve block [39]; and femoral nerve block and pudendal and paracervical block [7]. For the pairwise metaanalysis, the epidural analgesia arm was excluded for two studies [45,53]. The combination of intervention arms and exclusion of the epidural analgesia arm was performed according to the Cochrane Collaboration guidelines [25].…”

Section: Data Synthesismentioning

confidence: 99%

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Jiménez-Almonte

Wyles

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy. Questions/purposes We asked, when compared with a placebo, (1) does use of local infiltration analgesia reduce patient pain scores and opioid consumption, (2) does use of peripheral nerve blocks reduce patient pain scores and opioid consumption, and (3) is local infiltration analgesia favored over peripheral nerve blocks for postoperative pain management after THA? Methods We searched six databases, from inception through June 30, 2014, to identify RCTs comparing local infiltration analgesia or peripheral nerve block use in patients after THA. A total of 35 RCTs at low risk of bias based on the recommended Cochrane Collaboration risk assessment tool were included in the network meta-analysis (2296 patients). Primary outcomes for this review were patient pain scores at rest and cumulative opioid consumption, both assessed at 24 hours after THA. Because of substantial heterogeneity (variation of outcomes between studies) across included trials, a random effect model for meta-analysis was used to estimate the weighted mean difference (WMD) and 95% CI. The gray literature was searched with the same inclusion criteria as published One of the authors certifies that he (RJS), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000, from Biomet Inc (Warsaw, IN, USA 123Clin Orthop Relat Res (2016) 474:495-516 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® trials. Only one unpublished trial (published abstract) fulfilled our criteria and was included in this review. All other studies included in this systematic review were full published articles. Bayesian network meta-analysis included all RCTs that compared local infiltration analgesia or peripheral nerve blocks with placebo (or no intervention), epidural analgesia, and intrathecal morphine. Results Compared with placebo, local infiltration analgesia reduced patient pain scores (WMD, À0.61; 95% CI, À0.97 to À0.24; p = 0.001) and opioid consumption (WMD, À7.16 mg; 95% CI, À11.98 to À2.35; p = 0.004). Peripheral nerve blocks did not result in lower pain scores or reduced opioid consumption compared with placebo (WMD, À0.43; 95% CI, À0.99 to 0.12; p = 0.12 and WMD, À3.14 mg, 95% CI, À11.30 to 5.02; p = 0.45). However, network meta-analysis comparing local infiltration analgesia with peripheral nerve blocks through common comparators showed no differences between postoperative pain scores (WMD, À0.36; 95% CI, À1.06 to 0.31) and opioid consumption (WMD, À4....

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“…After reading full texts, 7 citations which did not fulfill the inclusion criteria were excluded. Finally, 9 RCTs were identified in our study ( Figure 1) [10][11][12][13][14][15][16][17][18].…”

Section: Search Resultsmentioning

confidence: 98%

“…Studies have shown that LIA is consistently more effective in the treatment of postoperative pain after TKA or THA when compared with placebo [8,9]. Comparison between LIA and epidural analgesia was conducted by several authors, which was more convincing to illustrate its superiority [10][11][12][13][14][15][16][17][18]. Tsukada et al [16] have shown that local infiltration was associated with a lower visual analog scale (VAS) score and better flexion motion than epidural analgesia, while Jules-Elysee et al [14] reported that epidural analgesia provided less opioid and a lower VAS score.…”

Section: Introductionmentioning

confidence: 99%

Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis

Huang

Cang

Zhao

et al. 2016

Bosn J of Basic Med Sci

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Pain management after total knee arthroplasty (TKA) and total hip arthroplasty should permit early mobilization with minimal pain. Local infiltration analgesia (LIA) is a new popular method for decreasing postoperative pain. The goal of this meta-analysis is to evaluate the efficacy of LIA in comparison with epidural analgesia. A literature search was performed in PubMed, EMBASE, the OVID database, Web of Science, and the Cochrane Library databases. The risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included visual analog scale score, range of flexion, length of stay, and complications. Nine trials involving 537 patients met the inclusion criteria. LIA provides better pain relief and larger range of motion in TKA patients compared to epidural analgesia at the late postoperative period. No significant difference was observed in regard to the length of stay and complications. The current evidence shows that the use of local infiltration is effective for postoperative pain management in TKA patients. More high-quality randomized controlled trials with long-term follow-up are required for examining the long-term efficacy and safety of local infiltration.

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Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia

Abstract: In our study periarticular infiltration was clearly superior to PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.

Cited by 37 publications

References 22 publications

Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness

Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis

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