A comparison of the analgesic efficacy of local infiltration analgesia vs. intrathecal morphine after total knee replacement

McCarthy, Denise M.; McNamara, John R.; Galbraith, John G.; Loughnane, Frank; Shorten, George; Iohom, Gabriella

doi:10.1097/eja.0000000000000943

Cited by 20 publications

(13 citation statements)

References 48 publications

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“…After full-text reading and screening, the remaining 13 articles were retrieved and read, and no studies were excluded according to the inclusion criteria. Finally, we included a total of 13 studies [ 7 , 11 – 22 ] for this meta-analysis, incorporating 942 patients. The study selection is outlined in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The impacts of pain relief are mainly reflected in the reduction of pain intensity with rest or mobilization for more than 6 hours or even 72 hours. McCarthy et al [ 7 ] conducted an RCT and revealed that LIA was superior to ITM for relieving pain at 48 h in TKA patients. Moreover, Jiménez-Almonte et al [ 25 ] conducted a systematic review and network meta-analysis and predicted that LIA may be the best treatment measure for TKA and THA patients.…”

Section: Discussionmentioning

confidence: 99%

“…Some controversies remain, however, regarding the pain control efficacy and safety of these 2 methods. McCarthy et al [ 7 ] conducted a randomized controlled trial and revealed that LIA conferred superior analgesia to ITM following TKA in patients. Hess et al [ 8 ] also suggested that ITM may not have a morphine-saving effect and may increase the occurrence of pruritus at doses over 0.3 mg.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Qiao

2020

Medicine

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Background: The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients. Methods: Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software. Results: We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours ( P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression). Conclusions: LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Qiao

2020

Medicine

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“…Among these, 140 were excluded because they were commentaries, 9 were excluded because they were case reports, 130 were excluded owing to being irrelevant studies, and 3 were excluded because they were systematic reviews. Finally, 11 intermediate-to high-quality studies [13,[15][16][17][18][19][20][21][22][23][24] were eligible for inclusion in this meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…However, it is still inconclusive as to which is preferable for pain relief in TJA. McCarthy et al [13] concluded that LIA conferred superior analgesia compared with intrathecal morphine at 24 and 48 h following TKA. While Rikalainen-Salmi et al reported that LIA might only enable early mobilization after THA, it was not associated with less nausea than ITM.…”

Section: Introductionmentioning

confidence: 99%

Intrathecal versus local infiltration analgesia for pain control in total joint arthroplasty

Cai¹,

Liu²,

Wu³

et al. 2020

J Orthop Surg Res

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Background: The purpose of this meta-analysis was to assess the efficacy of intrathecal morphine (ITM) analgesia and local infiltration analgesia (LIA) for pain control in total joint arthroplasty (TJA). Methods: Embase, PubMed, the Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs). All RCTs were comparing intrathecal analgesia and local infiltration analgesia in TJA. Primary outcomes were the visual analog scale (VAS) score with rest or mobilization up to 72 h. Secondary outcomes were the total morphine consumption, length of hospital stay, and morphine-related complications. Results: Compared with the intrathecal analgesia group, the LIA group was associated with a reduction in VAS score with rest up to 72 h. Moreover, LIA was associated with a decrease in VAS score with mobilization at 6 h, 12 h, 48 h, and 72 h. Moreover, LIA significantly reduced total morphine consumption (weighted mean difference (WMD) = − 15.37, 95% CI − 22.64 to − 8.83, P = 0.000), length of hospital stay (WMD = − 1.39, 95% CI − 1.67 to − 1.11, P = 0.000), and morphine-related complications (nausea and pruritus). Conclusions: Local infiltration provided superior analgesia and morphine-sparing effects within the first 72 h compared with ITM following TJA.

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Romer

Komann

Weinmann

et al. 2019

Schmerz

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A comparison of the analgesic efficacy of local infiltration analgesia vs. intrathecal morphine after total knee replacement

Cited by 20 publications

References 48 publications

Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Intrathecal versus local infiltration analgesia for pain control in total joint arthroplasty

Schmerz nach Knietotalendoprothese

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