The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies

Abstract

Introduction: The efficacy of intra-articular fentanyl supplementation for pain control after knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intra-articular fentanyl supplementation for pain intensity after arthroscopic knee surgery. Methods: We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through May 2019 for randomized controlled trials (RCTs) assessing the efficacy and safety of intra-articular fentanyl supplementation for arthroscopic knee surgery. This meta-analysis is performed using the random-effects model. Results: Four RCTs are included in the meta-analysis. Overall, compared with control group after knee arthroscopy, intra-articular fentanyl supplementation is associated with reduced pain scores at 1 h (standard mean difference (Std MD) = −3.50; 95% confidence interval (CI) = −5.68 to −1.32; p = 0.002), 2 h (Std MD = −4.73; 95% CI = −8.75 to −0.71; p = 0.02), and 8 h (Std MD = −5.02; 95% CI = −9.73 to −0.30; p = 0.04) but shows no substantial impact on pain scores at 4 h (Std MD = −3.94; 95% CI = −7.93 to 0.05; p = 0.05) or the supplementary analgesia (risk ratio = 0.56; 95% CI = 0.09–3.59; p = 0.54). Conclusions: Intra-articular fentanyl supplementation does benefit in pain control after knee arthroscopy.

Do intra‐articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta‐analysis

“…Zeng et al 36 in a meta‐analysis have shown that a single intra‐articular injection of morphine after knee arthroscopy provides better pain relief and reduces the need for supplementary analgesics in the immediate post‐operative period. Similarly, meta‐analytic studies for intra‐articular fentanyl and tramadol have reported better pain relief after knee arthroscopy 8,9 . An RCT has also demonstrated significantly reduced pain scores up to 24 hours with intra‐articular buprenorphine after knee arthroscopy 37 .…”

“…20,35 Zeng et al 36 tramadol have reported better pain relief after knee arthroscopy. 8,9 An RCT has also demonstrated significantly reduced pain scores up to 24 hours with intra-articular buprenorphine after knee arthroscopy. 37 It is important to note that the use of intra-articular opioids in knee procedures have focused on pain relief only in the immediate post-operative period (up to 24 hours after surgery), unlike trials on TMJ arthrocentesis where the focus was on improving outcomes at short-term follow-up.…”

“…Several clinical trials have attempted to improve the efficacy of TMJ arthrocentesis by injecting corticosteroids, sodium hyaluronate, platelet‐rich plasma, etc into the joint space 5‐7 . Experience from arthroscopy procedures on knee joints has demonstrated that intra‐articular analgesics may be injected at the end of the procedure to provide early pain relief 8,9 . Inspired by these trials, several clinicians have also experimented with the use of intra‐articular analgesics after TMJ arthrocentesis 10,11 .…”

“…[5][6][7] Experience from arthroscopy procedures on knee joints has demonstrated that intra-articular analgesics may be injected at the end of the procedure to provide early pain relief. 8,9 Inspired by these trials, several clinicians have also experimented with the use of intra-articular analgesics after TMJ arthrocentesis. 10,11 In 2018, Gopalakrishnan et al 5 conducted a systematic review to analyse the evidence on the efficacy of such intra-articular drugs after TMJ arthrocentesis.…”

Analgesic Effect of Intra-Articular Dexamethasone versus Fentanyl added as an adjuvant to Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery

“…The sample size was calculated using Power Analysis and Sample Size software program (PASS) version 11.0.4 using a one-way ANOVA based on previously published results (3,13) about the time to first request of analgesia as the primary outcome. Assuming that SD was 1 and the calculated effect size (f) was 0.43, a sample size of 87 equally divided into three groups can achieve 95% power with a 0.05 significance level.…”