Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: A meta-analysis

Yun, Xiang-Dong; Yin, Xiaoli; Jiang, Jin; Teng, Yuanjun; Dong, Haoxu; An, Liping; Xia, Yayi

doi:10.1016/j.otsr.2015.03.015

Cited by 53 publications

(33 citation statements)

References 32 publications

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“…77 There is a growing body of literature addressing the role of LIA vs peripheral nerve block. [78][79][80] As with epidural analgesia, it is possible that the future of LIA research and practice involves advances in multimodal analgesia and combination with single-injection peripheral nerve block.…”

Section: Postoperative Analgesiamentioning

confidence: 99%

Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence

Soffin

YaDeau

2016

British Journal of Anaesthesia

254

172

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Enhanced recovery after surgery (ERAS) protocols produce significant clinical and economic benefits in a range of surgical subspecialties. There is a long tradition of applying clinical pathways to the perioperative care of joint arthroplasty patients. Enhanced recovery after surgery represents the next step in the evolution of standardized care. To date, reports of full ERAS pathways for hip or knee arthroplasty are lacking. In this narrative review, we present the evidence base that can be usefully applied to constructing ERAS pathways for hip or knee arthroplasty. The history and rationale for applying ERAS to joint arthroplasty are explained. Evidence demonstrates improved outcomes after joint arthroplasty when a standardized approach to care is implemented. The efficacy of individual ERAS components in hip or knee replacement is considered, including preoperative education, intraoperative anaesthetic techniques, postoperative analgesia, and early mobilization after joint arthroplasty. Interventions lacking high-quality evidence are identified, together with recommendations for future research. Based on currently available evidence, we present a model ERAS pathway that can be applied to perioperative care of patients undergoing hip or knee arthroplasty.

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Section: Postoperative Analgesiamentioning

confidence: 99%

Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence

Soffin

YaDeau

2016

British Journal of Anaesthesia

254

172

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“…Ein Review zeigt einen beschränkten Nutzen der kontinuierlichen lokalen Infiltration im Rahmen multimodaler postoperativer Therapiekonzepte bei Knieund Hüftgelenksersatzoperationen [11]. Anderen Arbeiten zufolge lässt sich mit dieser Methode der Opioidbedarf reduzieren und eine effektive Schmerzlinderung erreichen [44,169].…”

Section: Eingriffe Im Bereich Der Hinteren Schädelgrubeunclassified

Interdisziplinäres Positionspapier „Perioperatives Schmerzmanagement“

Likar

Jaksch

Aigmüller

et al. 2017

Schmerz

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Despite many positive developments, postoperative pain and its treatment is still not always given the necessary attention. Severe pain after surgical procedures affects a significant proportion of patients. This very fact is not only detrimental to the immediate recovery process, but can also form the basis for the development of chronic pain conditions.An adequate and effective management of perioperative pain requires appropriate organizational structures. This multidisciplinary paper which was initiated by the Austrian Society for Anaesthesiology and Intensive Care and the Austrian Pain Society and developed together with numerous specialist and professional societies dealing with the subject aims at supporting the organization of perioperative pain management structures and to make best use of proven concepts. Additional recommendations describe specific interventions for selected types of intervention.

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“…assessment, [15][16][17][18] the fact that they do not address this question directly, 19 or did not investigate the relative benefit of each intervention on functional recovery. 20 This meta-analysis aims to compare the analgesic efficacy, the functional outcomes and the technique-related complications of FNB and LIA after TKA in adult patients.…”

mentioning

confidence: 99%

The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis

Albrecht

Guyen

Jacot-Guillarmod

et al. 2016

British Journal of Anaesthesia

109

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Many consider femoral nerve block the gold standard in pain management following knee arthroplasty. Local infiltration analgesia is an alternate approach that applies the concept of surgical wound infiltration with local anaesthetics. This meta-analysis aims to compare both analgesic treatments for analgesia and functional outcomes after total knee arthroplasty. This meta-analysis was performed according to the PRISMA statement guidelines. The primary outcomes were cumulative i.v. morphine consumption, pain scores at rest and on movement on postoperative day one (analogue scale,0-10). Secondary outcomes included range of motion, quadriceps muscle strength, length of stay and rates of complications (neurologic events, cardiovascular events, falls and knee infections). Fourteen trials, including 1122 adult patients were identified. There was no difference in i.v. morphine consumption (mean difference: -2.0 mg; 95% CI: -4.9, 0.9 mg; I(2)=69%; P=0.19), pain scores at rest (mean difference: -0.1; 95% CI: -0.4, 0.3; I(2)=72%; P=0.80) and pain scores on movement (mean difference: 0.2; 95% CI: -0.5, 0.8; I(2)=80%; P=0.64) on postoperative day one (a negative mean difference favours local infiltration analgesia). The qualities of evidence for our primary outcomes were moderate according to the GRADE system. There were no clinical differences in functional outcomes or rates of complications. Complication rates were captured by three trials or fewer with exception of knee infection, which was sought by eight trials. Local infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. Although this meta-analysis did not capture any difference in rates of complications, the low number of trials that specifically sought these outcomes dictates caution.

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Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: A meta-analysis

Abstract: Level II, meta-analysis and systematic review.

Cited by 53 publications

References 32 publications

Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence

Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence

Interdisziplinäres Positionspapier „Perioperatives Schmerzmanagement“

The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis

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