The efficacy of femoral nerve block for postoperative analgesia of total knee replacement: an overview of the systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

CHENG Xu ¹ , ZHENG Linli ² , XU Yi ¹ , WU Jiahui ¹ ,  ZHANG Wensheng ^1,3

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. West China School of Medicine, Sichuan University, Chengdu, 610041, P.R.China;
3. Laboratory of Anesthesia and Critical Care, Emergency Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

ZHANG Wensheng, Email: zhangws@vip.163.com

Keywords：

Femoral nerve block; Total knee replacement; Systematic review; Overview of systematic review

DOI：

10.7507/1672-2531.201701071

Video：

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Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNBvs. LIA, PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews’ results showed that: at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients’ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.

Citation： CHENG Xu, ZHENG Linli, XU Yi, WU Jiahui, ZHANG Wensheng. The efficacy of femoral nerve block for postoperative analgesia of total knee replacement: an overview of the systematic reviews. Chinese Journal of Evidence-Based Medicine, 2017, 17(3): 283-290. doi: 10.7507/1672-2531.201701071 Copy

1.	Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum, 2000, 43(9): 1905-1915.
2.	Richmond J, Hunter D, Irrgang J, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am, 2010, 92(4): 990-993.
3.	Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage, 2010, 18(4): 476-499.
4.	Wylde V, Jeffery A, Dieppe P, et al. The assessment of persistent pain after joint replacement. Osteoarthritis Cartilage, 2012, 20(2): 102-105.
5.	Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America, 2005, 23(1): 21-36.
6.	Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg, 2007, 104(3): 689-702.
7.	Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet, 2006, 367(9522): 1618-1625.
8.	Bourne MH. Analgesics for orthopedic postoperative pain. Am J Orthop (Belle Mead NJ), 2004, 33(3): 128-135.
9.	Patel N, Solovyova O, Matthews G, et al. Safety and efficacy of continuous femoral nerve catheter with single shot sciatic nerve block vs epidural catheter anesthesia for same-day bilateral total knee arthroplasty. J Arthroplasty, 2015, 30(2): 330-334.
10.	Jaeger P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med, 2013, 38(6): 526-532.
11.	Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty, 2014, 29(11): 2224-2229.
12.	Chen J, Lesser JB, Hadzic A, et al. Adductor canal block can result in motor block of the quadriceps muscle. Reg Anesth Pain Med, 2014, 39(2): 170-171.
13.	熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具 AMSTAR. 中国循证医学杂志, 2011, 11(9): 1084-1089.
14.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
15.	Albrecht E, Guyen O, Jacot-Guillarmod A, et al. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2016, 116(5): 597-609.
16.	Chan EY, Fransen M, Parker DA, et al. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev, 2014, (5): CD009941.
17.	Dong CC, Dong SL, He FC. Comparison of adductor canal block and femoral nerve block for postoperative pain in total knee arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore), 2016, 95(12): e2983.
18.	Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth, 2008, 100(2): 154-164.
19.	Kuang MJ, Xu LY, Ma JX, et al. Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: A meta-analysis. Int J Surg, 2016, 31: 17-24.
20.	Li D, Ma GG. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2614-2619.
21.	Li D, Yang Z, Xie X, et al. Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop, 2016, 40(5): 925-933.
22.	Mei S, Jin S, Chen Z, et al. Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block. Clinics (Sao Paulo), 2015, 70(9): 648-653.
23.	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.
24.	Wang C, Cai XZ, Yan SG. Comparison of periarticular multimodal drug injection and femoral nerve block for postoperative pain management in total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty, 2015, 30(7): 1281-1286.
25.	Yun XD, Yin XL, Jiang J, et al. Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res, 2015, 101(5): 565-569.
26.	Zhao XQ, Jiang N, Yuan FF, et al. The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis. J Anesth, 2016, 30(5): 745-754.
27.	黄天丰, 张扬, 方向志. 股神经阻滞用于全膝关节置换术患者术后镇痛的 Meta 分析. 国际麻醉学与复苏杂志, 2016, 37(3): 230-235.
28.	万晶. 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, 28(7): 101-105.
29.	余光书, 林焱斌, 黄显贵. 连续股神经阻滞镇痛与自控静脉镇痛在全膝关节置换术后镇痛的 Meta 分析. 中国矫形外科杂志, 2014, 22(16): 1441-1448.
30.	张启栋, 刘朝晖, 程立明. 全膝关节置换应用股神经阻滞镇痛与自控静脉镇痛的系统评价. 中国组织工程研究, 2013, 17(17): 3073-3080.
31.	Abdallah FW, Madjdpour C, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis. Can J Anaesth, 2016, 63(5): 552-568.
32.	袁志明, 魏建仝, 温景荣. 全膝关节置换后持续股神经阻滞与持续硬膜外镇痛的 Meta 分析. 中国组织工程研究, 2015, 19(35): 5728-5734.
33.	Puolakka PA, Rorarius MG, Roviola M,et al. Persistent pain following knee arthroplasty. Eur J Anaesthesthesiol, 2010, 27(5): 455-460.

1. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum, 2000, 43(9): 1905-1915.
2. Richmond J, Hunter D, Irrgang J, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am, 2010, 92(4): 990-993.
3. Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage, 2010, 18(4): 476-499.
4. Wylde V, Jeffery A, Dieppe P, et al. The assessment of persistent pain after joint replacement. Osteoarthritis Cartilage, 2012, 20(2): 102-105.
5. Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America, 2005, 23(1): 21-36.
6. Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg, 2007, 104(3): 689-702.
7. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet, 2006, 367(9522): 1618-1625.
8. Bourne MH. Analgesics for orthopedic postoperative pain. Am J Orthop (Belle Mead NJ), 2004, 33(3): 128-135.
9. Patel N, Solovyova O, Matthews G, et al. Safety and efficacy of continuous femoral nerve catheter with single shot sciatic nerve block vs epidural catheter anesthesia for same-day bilateral total knee arthroplasty. J Arthroplasty, 2015, 30(2): 330-334.
10. Jaeger P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med, 2013, 38(6): 526-532.
11. Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty, 2014, 29(11): 2224-2229.
12. Chen J, Lesser JB, Hadzic A, et al. Adductor canal block can result in motor block of the quadriceps muscle. Reg Anesth Pain Med, 2014, 39(2): 170-171.
13. 熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具 AMSTAR. 中国循证医学杂志, 2011, 11(9): 1084-1089.
14. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
15. Albrecht E, Guyen O, Jacot-Guillarmod A, et al. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2016, 116(5): 597-609.
16. Chan EY, Fransen M, Parker DA, et al. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev, 2014, (5): CD009941.
17. Dong CC, Dong SL, He FC. Comparison of adductor canal block and femoral nerve block for postoperative pain in total knee arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore), 2016, 95(12): e2983.
18. Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth, 2008, 100(2): 154-164.
19. Kuang MJ, Xu LY, Ma JX, et al. Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: A meta-analysis. Int J Surg, 2016, 31: 17-24.
20. Li D, Ma GG. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2614-2619.
21. Li D, Yang Z, Xie X, et al. Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop, 2016, 40(5): 925-933.
22. Mei S, Jin S, Chen Z, et al. Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block. Clinics (Sao Paulo), 2015, 70(9): 648-653.
23. 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.
24. Wang C, Cai XZ, Yan SG. Comparison of periarticular multimodal drug injection and femoral nerve block for postoperative pain management in total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty, 2015, 30(7): 1281-1286.
25. Yun XD, Yin XL, Jiang J, et al. Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res, 2015, 101(5): 565-569.
26. Zhao XQ, Jiang N, Yuan FF, et al. The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis. J Anesth, 2016, 30(5): 745-754.
27. 黄天丰, 张扬, 方向志. 股神经阻滞用于全膝关节置换术患者术后镇痛的 Meta 分析. 国际麻醉学与复苏杂志, 2016, 37(3): 230-235.
28. 万晶. 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, 28(7): 101-105.
29. 余光书, 林焱斌, 黄显贵. 连续股神经阻滞镇痛与自控静脉镇痛在全膝关节置换术后镇痛的 Meta 分析. 中国矫形外科杂志, 2014, 22(16): 1441-1448.
30. 张启栋, 刘朝晖, 程立明. 全膝关节置换应用股神经阻滞镇痛与自控静脉镇痛的系统评价. 中国组织工程研究, 2013, 17(17): 3073-3080.
31. Abdallah FW, Madjdpour C, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis. Can J Anaesth, 2016, 63(5): 552-568.
32. 袁志明, 魏建仝, 温景荣. 全膝关节置换后持续股神经阻滞与持续硬膜外镇痛的 Meta 分析. 中国组织工程研究, 2015, 19(35): 5728-5734.
33. Puolakka PA, Rorarius MG, Roviola M,et al. Persistent pain following knee arthroplasty. Eur J Anaesthesthesiol, 2010, 27(5): 455-460.

Chinese Journal of Evidence-Based Medicine

The efficacy of femoral nerve block for postoperative analgesia of total knee replacement: an overview of the systematic reviews

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