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

Liu, Yuan; Zeng, Junfeng; Zeng, Yi; Wu, Yuangang; Bao, Xianchao; Shen, Bin

doi:10.1111/os.12547

Cited by 10 publications

(8 citation statements)

References 39 publications

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“…Another meta-analysis 191 found that the use of continuous peripheral nerve blocks (FNB or ACB) does not provide superior analgesic benefit over single shot LIA. The potential benefits of using liposomal bupivacaine has been evaluated in six meta-analyses 125,[192][193][194][195][196][197] and a Cochrane review. 198 The role of liposomal bupivacaine in LIA for TKA remains unclear because of conflicting evidence.…”

Section: Local Infiltration Analgesiamentioning

confidence: 99%

Pain management after total knee arthroplasty

Lavand’homme¹,

Kehlet²,

Rawal³

et al. 2022

European Journal of Anaesthesiology

103

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BACKGROUND The PROSPECT (PROcedure SPEcific Postoperative Pain ManagemenT) Working Group is a global collaboration of surgeons and anaesthesiologists formulating procedure-specific recommendations for pain management after common operations. Total knee arthroplasty (TKA) is associated with significant postoperative pain that is difficult to treat. Nevertheless, pain control is essential for rehabilitation and to enhance recovery. OBJECTIVE To evaluate the available literature and develop recommendations for optimal pain management after unilateral primary TKA.DESIGN A narrative review based on published systematic reviews and meta-analyses, using modified PROSPECT methodology.DATA SOURCES A literature search was performed in EMBASE, MEDLINE, PubMed and Cochrane Databases, between January 2014 and December 2020, for systematic reviews and meta-analyses evaluating analgesic interventions for pain management in patients undergoing TKA.ELIGIBILITY CRITERIA Each randomised controlled trial (RCT) included in the selected systematic reviews was critically evaluated and included only if met the PROSPECT requirements. Included studies were evaluated for clinically relevant differences in pain scores, use of nonopioid analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs and current clinical relevance.RESULTS A total of 151 systematic reviews were analysed, 106 RCTs met PROSPECT criteria. Paracetamol and nonsteroidal anti-inflammatory or cyclo-oxygenase-2-specific inhibitors are recommended. This should be combined with a single shot adductor canal block and peri-articular local infiltration analgesia together with a single intra-operative dose of intravenous dexamethasone. Intrathecal morphine (100 mg) may be considered in hospitalised patients only in situations when both adductor canal block and local infiltration analgesia are not possible. Opioids should be reserved as rescue analgesics in the postoperative period. Analgesic interventions that could not be recommended were also identified.CONCLUSION The present review identified an optimal analgesic regimen for unilateral primary TKA. Future studies to evaluate enhanced recovery programs and specific challenging patient groups are needed.

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Section: Local Infiltration Analgesiamentioning

confidence: 99%

Pain management after total knee arthroplasty

Lavand’homme¹,

Kehlet²,

Rawal³

et al. 2022

European Journal of Anaesthesiology

103

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“… 114 Similarly, a recent meta-analysis showed that periarticular injection with liposomal bupivacaine is associated with faster functional recovery but no difference in pain scores was seen when compared with FNB. 115 However, another meta-analysis compared liposomal bupivacaine in periarticular injections for TKA with traditional LAs and found no clinical difference in pain reduction neither opioid consumption 116 . Although, the authors acknowledge the lack of studies with comparable procedures, which may limit their conclusions.…”

Section: Long-acting Anestheticsmentioning

confidence: 99%

A guide to regional analgesia for Total Knee Arthroplasty

Rodriguez-Patarroyo

Cuello²,

Molloy

et al. 2021

EFORT Open Reviews

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Regional analgesia has been introduced successfully into the postoperative pain management after total knee arthroplasty, reducing pain scores, opioid use and adverse effects. Combination of regional analgesia techniques is associated with better pain management and lower side effects than single regional techniques. Adductor canal block provides good analgesia and considerably lower detrimental effect in muscular strength than femoral nerve block, enhancing surgical recovery. Infiltration techniques may have equivalent analgesic effect than epidural analgesia and peripheral nerve blocks, however there should be awareness of dose dependent toxicity. Novel long-acting local anesthetics role for regional analgesia is still to be determined, and will require larger randomized trials to support its advantage over traditional local anesthetics. Cite this article: EFORT Open Rev 2021;6:1181-1192. DOI: 10.1302/2058-5241.6.210045

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“…Total knee arthroplasty (TKA) is 1 of the most effective methods for end-stage of knee osteoarthritis (OA) and improve the quality of life of patients. [ 1 , 2 ] According to epidemiological statistics of OA, the incidence of OA in people over 65 years and over 80 years old can reach 50% and 80% respectively. [ 3 ] Over 90 000 TKAs are performed annually in England and Wales.…”

Section: Introductionmentioning

confidence: 99%

Administration with corticosteroid relieving pain following total knee arthroplasty

Zhang¹,

Huang

2020

Medicine

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Background: This meta-analysis compares the effectiveness of corticosteroid in relieving pain and inflammation in total knee arthroplasty (TKA) patients. Method: Randomized controlled trials in PubMed (1996 to March 2020), Embase (1996 to March 2020), and the Cochrane Library (CENTRAL, March 2020) compared corticosteroid and placebo in pain in TKA patients were identified by a software and manual searching. The risk of bias and clinical relevance of the included studies were assessed. Sensitivity analysis was performed by omitting each study in turn. The major outcomes of the studies were analyzed by the Stata 12.0. Results: 13 randomized controlled trials that involved 193 patients were included in the present meta-analysis. The results of the study revealed a significantly lower visual analog scale (VAS) score of pain at rest in the corticosteroid group (12 hours: weighted mean difference (WMD)=−1.35, P = .005; 24 hours: WMD=−1.11, P = .000; 48 hours: WMD=−0.31, P = .000; 72 hours: WMD = −0.30, P = .000). And Postoperative VAS scores during mobilization at 12 hours and 24 hours were significantly lower at corticosteroid group when compared with control group (12 hours: WMD = −0.81, P = 0.000; 24 hours: WMD = −1.66, P = .018). Meta-analyses show that administration of corticosteroid can reduce the length of hospital stay, incidence nausea and the C-reactive protein level. While no significant difference was observed in the VAS scores during mobilization at 48 hours and 72 hours and total morphine consumption ( P > .05). Conclusions: Compared to the control group, intraoperative corticosteroid was benefit to the pain management in TKA. However, more high-quality studies are still warranted to further validate our findings, considering there are several limitations in this meta-analysis.

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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

Cited by 10 publications

References 39 publications

Pain management after total knee arthroplasty

Pain management after total knee arthroplasty

A guide to regional analgesia for Total Knee Arthroplasty

Administration with corticosteroid relieving pain following total knee arthroplasty

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