The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty

Seangleulur, Alisa; Vanasbodeekul, Pramook; Prapaitrakool, Sunisa; Worathongchai, Sukhumakorn; Anothaisintawee, Thunyarat; McEvoy, Mark; Vendittoli, Pascal‐André; Attia, John; Thakkinstian, Ammarin

doi:10.1097/eja.0000000000000516

Cited by 100 publications

(54 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although numerous meta-analyses have attempted to determine whether FNB or ACB is superior, conflicting results have emerged 31–35. While some meta-analyses have found ACBs to be equivalent to FNBs in terms of pain control at rest and with movement, strength of quadriceps and adductor muscles, LOS, and incidence of nausea and vomiting,31 others have found ACBs to be superior.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

“…Seangleulur et al35 examined the analgesic efficacy of PAI compared to placebo/no injection in patients undergoing TKA. The PAI group had lower pain scores, opioid consumption and postoperative nausea/vomiting, higher range of motion at 24 hours, and shorter LOS than no injection or placebo 35.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

“…The PAI group had lower pain scores, opioid consumption and postoperative nausea/vomiting, higher range of motion at 24 hours, and shorter LOS than no injection or placebo 35. Again it is important to note that study variation such as type of medication used, dose, and volume can alter the efficacy of the PAI.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

See 2 more Smart Citations

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Turnbull

Sastow

Giambrone

et al. 2017

LRA

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality. Anesthesiologists are also moving toward multimodal analgesia, which includes peripheral nerve blockade, periarticular injection, and preemptive analgesia. The goal of multimodal analgesia is to improve perioperative pain control while minimizing systemic narcotic consumption. With improved postoperative pain management and rapid patient rehabilitation, new clinical pathways have been engineered to fast track patient recovery after orthopedic procedures. The aim of these clinical pathways was to improve quality of care, minimize unnecessary variations in care, and reduce cost by using streamlined procedures and protocols. The future of TKA care will be formalized clinical pathways and tracks to better optimize perioperative algorithms with regard to pain control and perioperative rehabilitation.

show abstract

Section: Multimodal Analgesiamentioning

confidence: 99%

Section: Multimodal Analgesiamentioning

confidence: 99%

See 1 more Smart Citation

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Turnbull

Sastow

Giambrone

et al. 2017

LRA

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

“…Local infiltration anesthesia (LIA) has been identified a successful and easy way to management postoperative pain, and promote early mobilization after TKA [8]. A meta-analysis indicated that LIA shows better pain control than FNB, which is considered to be the gold standard anesthesia method [9].…”

Section: Introductionmentioning

confidence: 99%

Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis

Zhang

Chang

2017

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) were to evaluate the effect and safety of local anesthetic infusion pump versus placebo for pain management following total knee arthroplasty (TKA).MethodsIn September 2016, a systematic computer-based search was conducted in the Pubmed, ISI Web of Knowledge, Embase, Cochrane Database of Systematic Reviews. Randomized controlled trials of patients prepared for primary TKA that compared local anesthetic infusion pump versus placebo for pain management following TKA were retrieved. The primary endpoint was the visual analogue scale (VAS) with rest or mobilization at 24, 48 and 72 h and morphine consumption at 24 and 48 h. The second outcomes are range of motion, length of hospital stay (LOS) and complications (infection, deep venous thrombosis (DVT), prolonged drainage and postoperative nausea and vomiting (PONV)).ResultsSeven clinical studies with 587 patients were included and for meta-analysis. Local anesthetic infusion pump are associated with less pain scores with rest or mobilization at 24 and 48 h with significant difference. However, the difference was likely no clinical significance. There were no significant difference between the LOS, the occurrence of DVT, prolonged drainage and PONV. However, local anesthetic infusion pump may be associated with more infection.ConclusionBased on the current meta-analysis, we found no evidence to support the routine use of local anesthetic infusion pump in the management of acute pain following TKA. More RCTs are still need to identify the pain control effects and optimal dose and speed of local anesthetic pain pump.

show abstract

The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty

Cited by 100 publications

References 69 publications

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

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

Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis

Contact Info

Product

Resources

About