Local Infiltration Analgesia Versus Continuous Femoral Nerve Block in Pain Relief After Total Knee Arthroplasty: A Randomized Controlled Trial

Kurosaka, Kenji; Tsukada, Sachiyuki; Seino, Daisuke; Morooka, T.; Nakayama, Hiroshi; Yoshiya, Shinichi

doi:10.1016/j.arth.2015.10.030

Cited by 84 publications

(59 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All the RCTs [10–14] provided clear inclusion and exclusion criteria, and suggested a methodology of randomization, demonstrating that the randomization algorithm was generated by a computer program. Furthermore, all RCTs stated allocation concealment was achieved by the sealed envelope approach.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

Ji¹,

2017

Medicine

View full text Add to dashboard Cite

Background:This meta-analysis aimed to evaluate the efficiency and safety of dexamethasone administration in total knee and hip arthroplasties.Methods:Two researchers search the relevant studies independently including Embase (1980–017.04), PubMed (1966–017.04), ScienceDirect (1985–017.04), Web of Science (1950–2017.03), and Cochrane Library for potential relevant studies. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary. The results of dichotomous outcomes were expressed as risk difference (RD) with a 95% confidence intervals (CIs). For continuous various outcomes, mean difference (MD) or standard mean difference (SMD) with a 95% confidence intervals (CIs) was applied for assessment. Meta-analysis was performed using Stata 11.0 software.Results:Four randomized controlled trials (RCTs) including 361 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 12 hours (SMD = −0.579, 95% CI: −0.780 to −0.357, P = .000), 24 hours (SMD = −0.820, 95% CI: −1.036 to −0.604, P = .000), and 48 hours (SMD = −0.661, 95% CI: −1.149 to −0.172, P = .008). Dexamethasone was associated with a lower opioid consumption at 12 hours (SMD = −0.245, 95% CI: −0.465 to −0.025, P = .029), 24 hours (SMD = −0.285, 95% CI: −0.505 to −0.064, P = .011), and 48 hours (SMD = −0.989, 95% CI: −1.710 to −0.267, P = .007).Conclusion:Dexamethasone could significantly reduce postoperative pain scores and opioid consumption within the 1st 48 hours following total joint arthroplasty (TJA). The overall evidence quality was moderate to low, further high-quality RCTs are needed to identify the optimal dose of dexamethasone for reducing pain after TJA.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Multiple perioperative pain management strategies have been implemented following TJA, including femoral nerve block (FNB), spinal analgesia, and periarticular or intraarticular injection of anesthetics. [14–16] …”

Section: Discussionmentioning

confidence: 99%

The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

Ji¹,

2017

Medicine

View full text Add to dashboard Cite

show abstract

“…[7,8] A mixture that comprises a long-acting local anesthetic, a nonsteroid anti-inflammatory drug and epinephrine is most commonly used in local infiltration. LIA is a promising method with fewer side effects that offers early mobilization without weakness of the quadriceps muscle.…”

Section: Introductionmentioning

confidence: 99%

Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty

2017

View full text Add to dashboard Cite

Background:To perform a meta-analysis to assess the efficiency and safety between local infiltration analgesia (LIA) and sciatic nerve block (SNB) when combined with femoral nerve block (FNB) for pain control following total knee arthroplasty (TKA).Methods:We systemically searched the following electronic databases for potentially relevant articles: Embase (1980–2017.01), Medline (1966–2017.01), PubMed (1966–2017.01), ScienceDirect (1985–2017.01), web of science (1950–2017.01) and the Cochrane Library. Only studies published in English that were accessible online were considered. Furthermore, we only considered studies that were published from 1966 to 2017. Only studies that met the following inclusion criteria were considered: (a) patients were adult human subjects who were set to undergo TKA; (b) the intervention was either SNB combined with FNB or LIA combined with FNB; (c) the outcomes of the studies, such as visual analog scale (VAS) scores, morphine consumption, length of stay and postoperative adverse effects, including the risk of nausea, vomiting and falls, were reported; (d) studies were either RCTs or non-RCT. Meta-analysis was performed using Stata 11.0 software. Modified Jadad score (7-points scale) which was based on Cochrane Handbook for Systematic Reviews of Interventions is used for assessment of RCTs. The Methodological Index for Nonrandomized Studies (MINORS) scale was used to assess non-RCTs with scores ranging 0 to 24. The synthesis of the outcomes for all studies was calculated as the weighted average rate by using a fixed or random effect model which depends on statistical heterogeneity. Systematic review registration number is CRD42017110661.Results:Three randomized controlled trials (RCTs) and 2 nonrandomized controlled trials (Non-RCTs), including 240 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = −0.337, 95% CI: −0.593 to −0.081, P =.010), VAS score at 24 hours (SMD = −0.337, 95% CI: −0.612 to −0.061, P =.017), morphine equivalent consumption at 24 hours (SMD = −0.371, 95% CI: −0.627 to −0.114, P = .005) and incidence of nausea (RD = 0.215, 95% CI: 0.078 to 0.353, P = .002) and vomiting (RD = 0.143, 95% CI: 0.026 to 0.260, P = .017).Conclusion:FNB combined with SNB provided decreased VAS scores and less morphine consumption at 12 and 24 hours compared with FNB combined with LIA in total knee arthroplasty. In addition, it was associated with lower risks of nausea and vomiting. We assessed the quality of the evidence as low to very low; therefore, our confidence in the effect estimate is limited, and the true effect may be substantially different from our estimates. Further studies should focus on surgeries that are known to be associated with significant postoperative pain, particularly surgeries where improved pain control may deliver significant clinical benefits through reduced morbidity, or cost-effectiveness benefits through faster r...

show abstract

“…In addition to compression and cooling, the multimodal approach includes surgery without a pneumonic tourniquet [5], periarticular multidrug injection [6], [7], and intravenous administration of tranexamic acid [8]. Although the knee pad developed to effectively compress the knee could improve swelling, there have been no reports regarding the effectiveness of such a compression pad following TKA.…”

Section: Introductionmentioning

confidence: 99%

Impact of postoperative compression dressing using polyethylene foam pad on the multimodal protocol for swelling control following total knee arthroplasty: a randomized controlled trial

Kayamori¹,

Tsukada²,

Satô³

et al. 2016

Arthroplasty Today

Self Cite

View full text Add to dashboard Cite

BackgroundThe multimodal approach is commonly applied to improve knee swelling after total knee arthroplasty. Although the use of a knee compression pad may improve knee swelling, its impact in the multimodal protocol remains unclear.MethodsA total of 57 knees were randomly assigned to one of 2 groups receiving treatment with either a compression dressing using a polyethylene foam pad designed to effectively compress the postoperative knee combined with an elastic bandage or a compression dressing with use of an elastic bandage only. All patients were treated with the multimodal approach, including an external cooling system, intravenous tranexamic acid, no pneumonic tourniquet, and periarticular multidrug injection.ResultsIn intention-to-treat analysis, the circumferences of the thigh measured on postoperative days 1 and 7 were not significantly different between the 2 groups. In addition, there were no differences between the 2 groups in knee flexion angle, perioperative total blood loss, or complication rate.ConclusionsThe polyethylene foam pad had no significant beneficial effect on knee swelling in patients undergoing total knee arthroplasty using the multimodal approach.

show abstract

Local Infiltration Analgesia Versus Continuous Femoral Nerve Block in Pain Relief After Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract: LIA was associated with better pain relief with a comparable complications rate for patients undergoing TKA than FNB. We recommend LIA for pain relief after TKA.

Cited by 84 publications

References 23 publications

The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty

Impact of postoperative compression dressing using polyethylene foam pad on the multimodal protocol for swelling control following total knee arthroplasty: a randomized controlled trial

Contact Info

Product

Resources

About