Local infiltration vs epidural analgesia for postoperative pain control after total knee or hip arthroplasty

Abstract

Background: Inconsistent results have been obtained regarding postoperative pain control using local infiltration and epidural analgesia for patients after total knee or hip arthroplasty (TKA and THA). We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of local infiltration vs epidural analgesia for TKA and THA. Methods: Electronic searches were conducted on PubMed, EmBase, and the Cochrane library to identify eligible RCTs conducted up to February 2020. Weighted mean difference (WMD) and relative risk with 95% confidence interval (95%CI) were applied to calculate pooled effect estimates between local infiltration and epidural analgesia using the random-effects model. Results: Seven RCTs including a total of 412 TKA patients, and three RCTs including a total of 200 THA patients were selected for this meta-analysis. We noted that local infiltration was associated with lower visual analog scale (VAS) scores at rest after 48 hours (WMD: −1.31; 95%CI: −2.44 to −0.18; P = .024) and 72 hours (WMD: −0.95; 95%CI: −1.39 to −0.52; P < .001) for patients with TKA, while local infiltration significantly reduced VAS scores at rest after 12 hours for patients with THA (WMD: −1.00; 95%CI: −1.49 to −0.51; P < .001). Moreover, local infiltration was associated with lower VAS scores during movement after 48 hours in TKA patients (WMD: −1.08; 95%CI: −1.86 to −0.29; P = .007), while there were higher VAS scores during movement after 24 hours for patients with THA (WMD: 1.06; 95%CI: 0.67 to 1.45; P < .001). Furthermore, we noted that local infiltration was associated with higher flexion angles compared with epidural analgesia after 24 hours (WMD: 7.11; 95%CI: 2.30–11.93; P = .004), 48 hours (WMD: 6.69; 95%CI: 3.78 to 9.59; P < .001), and 72 hours (WMD: 5.19; 95%CI: 0.95–9.44; P = .016). There were no significant differences between local infiltration and epidural analgesia for the length of hospital stay, nausea, or wound infection. Conclusions: Local infiltration is superior to epidural analgesia for postoperative pain control after TKA, whereas for THA patients inconsistent results were obtained at various times.

Efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block versus periarticular local infiltration analgesia after unilateral total knee arthroplasty

“…A recent meta-analysis showed that local anesthetic infiltration is superior to epidural analgesia for postoperative pain control after TKA. 23 Perhaps the doses and techniques used for periarticular LIA were likely inconsistent between the different operating surgeons in our study. Another systemic review and meta-analysis investigated and did not support adding iPACK block to ACB in the presence of periarticular LIA due to lack of any additional benefit.…”

Postoperative Pain Control by Local Infiltration Analgesia and Peripheral Nerve Block in Primary Prosthetic Total Knee Arthroplasty

“… 37 Also in line with previous studies, we showed a mutually indistinguishable effect of LIA and FSNB 24 hours after surgery, 38 which was superior to the effects of post-op epidural opioids and intrathecal analgesics. 39 , 40 Since the systemic toxicity of LIA can affect up to 11% of patients, the post-op monitoring of LIA patients cannot be ignored. 41 A similar observation was made by Tian et al; their retrospective TKA study showed that the short-term analgesic effect of LIA was similar to that of nerve block and reduced the need for opiate supplementation, and that LIA and nerve block had similar complication rates.…”

A guide to regional analgesia for Total Knee Arthroplasty

“…Several meta-analyses have compared the efficacy of LAI against other postoperative analgesic strategies. LAI is associated with superior analgesic effect than epidural analgesia 33 with lower incidence of nausea and vomiting and a wider range of articular motion. 95 In the case of FNB, there was a similar effect in pain control compared to LAI.…”

“… 31 However, neuroaxial analgesia was associated with higher incidence of hypotension, urinary retention, nausea and vomiting. 31 On the other hand, researchers found that local infiltration provides better analgesia management than either subarachnoid 32 or epidural analgesia 33 for TKA. In favor of reducing opioid use, epidural analgesia provides superior pain control than intravenous opioids.…”