Local Infiltration Analgesia versus Femoral Nerve Block for Total Knee Arthroplasty: A Systematic Review and Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 Ilyar·MAMTILI , YUJin , ZHAOPan , WUJian-jiang , WANGJiang ,  ZHENGHong

The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

ZHENGHong, Email: Xjzhenghong@aliyun.com

Keywords：

Local infiltration analgesia; Femoral nerve block; Total knee arthroplasty; Systematic review; Metaanalysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160181

Video：

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Objective To systematically evaluate the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 4, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was conducted using RevMan 5.3 software. Results A total of 13 RCTs involving 1 001 patients were included. The results of meta-analysis showed that: There were no significant differences in pain scores at rest (SMD=0.02, 95%CI -0.23 to 0.27, P=0.86), morphine consumption on movement (MD=-1.85, 95%CI -4.67 to 0.97, P=0.20), incidence of post-operative nausea and vomiting (RD=0.02, 95%CI -0.03 to 0.08, P=0.41) and incidence of post-operative knee infection (RD=0.01, 95%CI -0.02 to 0.03, P=0.60) between the two groups, but he local infiltration analgesia group had lower length of stay than the femoral nerve block group with statistical difference (SMD=-0.24, 95%CI -0.41 to -0.07, P=0.005). Conclusion Local infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies.

Citation： Ilyar·MAMTILI, YUJin, ZHAOPan, WUJian-jiang, WANGJiang, ZHENGHong. Local Infiltration Analgesia versus Femoral Nerve Block for Total Knee Arthroplasty: A Systematic Review and Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(10): 1192-1200. doi: 10.7507/1672-2531.20160181 Copy

1.	Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am, 2015, 95(2): 301-318.
2.	Albrecht E, Morfey D, Chan V, et al. Single-injection or continuous femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res, 2014, 472(5): 1384-1393.
3.	Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology, 2010, 113(5): 1144-1162.
4.	Bianconi M, Ferraro L, Traina GC, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth, 2003, 91(6): 830-835.
5.	Röstlund T, Kehlet H. High-dose local infiltration analgesia after hip and knee replacement——what is it, why does it work, and what are the future challenges? Acta Orthop, 2007, 78(2): 159-161.
6.	Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery-A case study of 325 patients. Acta Orthop, 2009, 79(2): 174-183.
7.	Affas F, Nygårds EB, Stiller CO, et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop, 2011, 82(4): 441-447.
8.	Ashraf A, Raut VV, Canty SJ, et al. Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block. Knee, 2013, 20(5): 324-327.
9.	Carli F, Clemente A, Asenjo JF, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth, 2010, 105(2): 185-195.
10.	Chaumeron A, Audy D, Drolet P, et al. Erratum to: periarticular injection in knee arthroplasty improves quadriceps function. Clin Orthop Relat Res, 2013, 471(6): 2284-2295.
11.	Fan L, Yu X, Zan P, et al. Comparison of local infiltration analgesia with femoral nerve block for total knee arthroplasty: a prospective, randomized clinical trial. J Arthroplasty, 2016, 31(6): 1361-1365.
12.	Kovalak E, Dogan AT, Uzumcugil O, et al. A comparison of continuous femoral nerve block and periarticular local infiltration analgesia in the management of early period pain developing after total knee arthroplasty. Acta Orthop Traumatol Turc, 2015, 49(3): 260-266.
13.	Kurosaka K, Tsukada S, Seino D, et al. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. J Arthroplasty, 2016, 31(4): 913-917.
14.	Moghtadaei M, Farahini H, Faiz SH, et al. Pain management for total knee arthroplasty: single-injection femoral nerve block versus local infiltration analgesia. Iran Red Crescent Med J, 2014, 16(1): e13247.
15.	Ng FY, Ng KF, Chiu KY, et al. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: a prospective, crossover, randomized clinical trial. J Arthroplasty, 2012, 27(6): 1234-1238.
16.	Parvataneni HK, Shah VP, Howard H, et al. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections. J Arthroplasty, 2007, 22(9): 33-38.
17.	Spangehl MJ, Clarke HD, Hentz JG, et al. The chitranjan ranawat award: periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res, 2015, 473(1): 45-53.
18.	Toftdahl K, Nikolajsen L, Haraldsted V, et al. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop, 2007, 78(2): 172-179.
19.	Uesugi K, Kitano N, Kikuchi T, et al. Comparison of peripheral nerve block with periarticular injection analgesia after total knee arthroplasty: a randomized, controlled study. Knee, 2014, 21(4): 848-852.
20.	De Ruyter ML, Brueilly KE, Harrison BA, et al. A pilot study on continuous femoral perineural catheter for analgesia after total knee arthroplasty: the effect on physical rehabilitation and outcomes. J Arthroplasty, 2006, 21(8): 1111-1117.
21.	Luo TD, Ashraf A, Dahm DL, et al. Femoral nerve block is associated with persistent strength deficits at 6 months after anterior cruciate ligament reconstruction in pediatric and adolescent patient. Am J Sports Med, 2015, 43(2): 331-336.
22.	Sharma S, Iorio R, Specht LM, et al. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res, 2010, 468(1): 135-140.
23.	万晶, 张怀奇, 陈凯, 等. 局部浸润麻醉对全膝关节置换术后镇痛效果的系统评价. 临床误诊误治, 2015, (7): 101-105.

1. Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am, 2015, 95(2): 301-318.
2. Albrecht E, Morfey D, Chan V, et al. Single-injection or continuous femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res, 2014, 472(5): 1384-1393.
3. Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology, 2010, 113(5): 1144-1162.
4. Bianconi M, Ferraro L, Traina GC, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth, 2003, 91(6): 830-835.
5. Röstlund T, Kehlet H. High-dose local infiltration analgesia after hip and knee replacement——what is it, why does it work, and what are the future challenges? Acta Orthop, 2007, 78(2): 159-161.
6. Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery-A case study of 325 patients. Acta Orthop, 2009, 79(2): 174-183.
7. Affas F, Nygårds EB, Stiller CO, et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop, 2011, 82(4): 441-447.
8. Ashraf A, Raut VV, Canty SJ, et al. Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block. Knee, 2013, 20(5): 324-327.
9. Carli F, Clemente A, Asenjo JF, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth, 2010, 105(2): 185-195.
10. Chaumeron A, Audy D, Drolet P, et al. Erratum to: periarticular injection in knee arthroplasty improves quadriceps function. Clin Orthop Relat Res, 2013, 471(6): 2284-2295.
11. Fan L, Yu X, Zan P, et al. Comparison of local infiltration analgesia with femoral nerve block for total knee arthroplasty: a prospective, randomized clinical trial. J Arthroplasty, 2016, 31(6): 1361-1365.
12. Kovalak E, Dogan AT, Uzumcugil O, et al. A comparison of continuous femoral nerve block and periarticular local infiltration analgesia in the management of early period pain developing after total knee arthroplasty. Acta Orthop Traumatol Turc, 2015, 49(3): 260-266.
13. Kurosaka K, Tsukada S, Seino D, et al. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. J Arthroplasty, 2016, 31(4): 913-917.
14. Moghtadaei M, Farahini H, Faiz SH, et al. Pain management for total knee arthroplasty: single-injection femoral nerve block versus local infiltration analgesia. Iran Red Crescent Med J, 2014, 16(1): e13247.
15. Ng FY, Ng KF, Chiu KY, et al. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: a prospective, crossover, randomized clinical trial. J Arthroplasty, 2012, 27(6): 1234-1238.
16. Parvataneni HK, Shah VP, Howard H, et al. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections. J Arthroplasty, 2007, 22(9): 33-38.
17. Spangehl MJ, Clarke HD, Hentz JG, et al. The chitranjan ranawat award: periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res, 2015, 473(1): 45-53.
18. Toftdahl K, Nikolajsen L, Haraldsted V, et al. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop, 2007, 78(2): 172-179.
19. Uesugi K, Kitano N, Kikuchi T, et al. Comparison of peripheral nerve block with periarticular injection analgesia after total knee arthroplasty: a randomized, controlled study. Knee, 2014, 21(4): 848-852.
20. De Ruyter ML, Brueilly KE, Harrison BA, et al. A pilot study on continuous femoral perineural catheter for analgesia after total knee arthroplasty: the effect on physical rehabilitation and outcomes. J Arthroplasty, 2006, 21(8): 1111-1117.
21. Luo TD, Ashraf A, Dahm DL, et al. Femoral nerve block is associated with persistent strength deficits at 6 months after anterior cruciate ligament reconstruction in pediatric and adolescent patient. Am J Sports Med, 2015, 43(2): 331-336.
22. Sharma S, Iorio R, Specht LM, et al. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res, 2010, 468(1): 135-140.
23. 万晶, 张怀奇, 陈凯, 等. 局部浸润麻醉对全膝关节置换术后镇痛效果的系统评价. 临床误诊误治, 2015, (7): 101-105.

Chinese Journal of Evidence-Based Medicine

Local Infiltration Analgesia versus Femoral Nerve Block for Total Knee Arthroplasty: A Systematic Review and Meta-analysis

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