Prospective Randomized Trial Comparing Femoral Nerve Block With Intraoperative Local Anesthetic Injection of Liposomal Bupivacaine in Total Knee Arthroplasty

Talmo, Carl T.; Kent, Suzanne E.; Fredette, Amanda N.; Anderson, Marie C.; Hassan, Mohd Fadzil; Mattingly, D

doi:10.1016/j.arth.2018.07.018

Cited by 17 publications

(17 citation statements)

References 20 publications

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“…Their results showed that LIA with LB improved postsurgical pain, opioid consumption (18.7 mg vs 84.9 mg, P = 0.0048), and time to first opioid rescue without side effects. Although another study showed that patients in an FNB group had significantly lower pain scores (mean 3.24 vs 3.87, P = 0.02) and higher range of motion (84.54° vs 78°, P < 0.001) in the first 24 h, the patients receiving LIA with LB were significantly more likely to perform a straight leg raise 12 h postoperatively (73% vs 50%; P = 0.0003) and scored better in the physical function component of the Short Form‐12 (−23 vs −27, P = 0.01) 3 months postoperatively. This suggested that LIA with LB provided excellent pain relief that was not inferior to FNB in patients undergoing TKA.…”

Section: Intraoperative Analgesic Regimensmentioning

confidence: 98%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

217

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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Section: Intraoperative Analgesic Regimensmentioning

confidence: 98%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

217

165

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“…reported the related outcomes but were excluded because of the repetition of data with another article included in our meta‐analysis. Finally, three RCT involving 457 patients and eight non‐RCT involving 2451 patients that compared LB with FNB were included (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

“…The baseline characteristics of each study are presented in Table . Five in eleven studies performed power analyses to estimate the sample size to acquire the significant result. The length of follow up ranged from 3 days to 1 year.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies involving 2349 patients referred to the visual analogue score (VAS) on the day of surgery (POD0). The final synthesis revealed that the LB is not significantly different from FNB ( MD = 0.15, 95% CI : [−0.45, 0.74], P = 0.63; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Two of them compare the efficacy of LB with FNB following TKA. However, the conclusions they attain are not completely coherent, and there are two recently published studies not included. Furthermore, outcomes relating to postoperative functional recovery, such as falls, range of motion (ROM), and ambulation distance were added to the new meta‐analysis.…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive Comparison of Liposomal Bupivacaine with Femoral Nerve Block for Pain Control Following Total Knee Arthroplasty: An Updated Systematic Review and Meta‐Analysis

Liu

Zeng

et al. 2019

Orthopaedic Surgery

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To compare the efficacy of liposomal bupivacaine (LB) and femoral nerve block following total knee arthroplasty, we conducted this systematic review and meta-analysis. 11 trials with 2,908 patients were included in this study. The pooled data demonstrated that total morphine consumption equivalents during the hospital stay was significantly increased in FNB group. In addition, LB has significantly better outcome in view of the postoperative functional recovery, such as the odds of fall, the incidences of straight leg rise (SLR), the number of patients who can walk independently in the day of surgery,the ambulation distance at POD1, the number of patients discharged at POD1. Consistent with the faster functional recovery, liposomal bupivacaine shortens the length of hospital stay. However, there was no significant difference between LB and FNB in terms of Visual Analogue Score (VAS) during the hospital stay. All in all, liposomal bupivacaine has significantly better outcome in view of the postoperative functional recovery and the length of hospital stay compared with femoral nerve block following the total knee arthroplasty.

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