Local infiltration analgesia following total knee arthroplasty: effect on post-operative pain and opioid consumption—a meta-analysis

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• 作者：Renée Keijsers ; Rogier van Delft…
• 关键词：Knee arthroplasty ; Analgesia ; Post ; operative pain ; Meta ; analysis
• 刊名：Knee Surgery, Sports Traumatology, Arthroscopy
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：23
• 期：7
• 页码：1956-1963
• 全文大小：623 KB
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  3.Andersen LO, Husted H, Kristensen BB, Otte KS, Gaarn-Larsen L, Kehlet H (2010) Analgesic efficacy of subcutaneous local anaesthetic wound infiltration in bilateral knee arthroplasty: a randomised, placebo-controlled, double-blind trial. Acta Anaesthesiol Scand 54(5):543-48PubMed View Article
  4.Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H (2008) A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta Orthop 79(6):806-11PubMed View Article
  5.Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H (2009) High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 52(10):1331-335View Article
  6.Andersen LO, Kristensen BB, Husted H, Otte KS, Kehlet H (2008) Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study. Acta Orthop 79(6):800-05PubMed View Article
  7.Bianconi M, Ferraro L, Traina GC, Zanoli G, Antonelli T, Guberti A et al (2003) Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth 91(6):830-35PubMed View Article
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  10.Essving P, Axelsson K, Aberg E, Spannar H, Gupta A, Lundin A (2011) Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth Analg 113(4):926-33PubMed
  11.Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A (2009) Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty. Acta Orthop 80(2):213-19PubMed Central PubMed View Article
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  14.Garcia JB, Barbosa Neto JO, Vasconcelos JW, Ferro LS, Silva RC (2010) Analgesic efficacy of the intra-articular administration of high doses of morphine in patients undergoing total knee arthroplasty. Rev Bras Anestesiol 60(1):1-2PubMed
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  21.Kristensen PK, Pfeiffer-Jensen M, Storm JO, Thillemann TM (2013) Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. doi:10.-007/?s00167-013-2399-x
• 作者单位：Renée Keijsers (1)
  Rogier van Delft (2)
  Michel P. J. van den Bekerom (3)
  Dirk C. A. A. de Vries (4)
  Richard M. Brohet (5)
  Peter A. Nolte (1)
  
  1. Department of Orthopaedic Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
  2. Departement of Anesthesiology, Leids Universitair Medisch Centrum, P.O.Box 9600, 2300RC, Leiden, The Netherlands
  3. Department of Orthopaedic Surgery, O.L.V.G., P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
  4. Department of Anesthesiology, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
  5. Research Center Linnaeus Insititute, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-7347

文摘

Introduction Local infiltration analgesia (LIA) is a popular method for decreasing post-operative pain after total knee arthroplasty (TKA). The goal of this meta-analysis is to compare the effect of LIA with placebo on the intensity of post-operative pain and the consumption of opioids. Methods A search was performed in the PubMed/MEDLINE, Cochrane, EMBASE and TRIP databases. All (quasi)-randomized controlled trials (RCTs) were included. LIA consists of intra-operative infiltration with at least one analgesic component. Data were pooled using Cochrane software. Results Seven placebo-controlled RCTs were included, involving 405 TKAs. On the first post-operative day, LIA provides an average decrease in VAS scores at rest of 12.3?% compared to placebo. Six RCTs studied opioid consumption in patients following TKA. There was a decrease in opioid consumption of 14.8?% compared to placebo 24?h after surgery. This suggests a reduced pain perception due to LIA. On the second post-operative day, the effect on both outcome measures was diminished and no longer significant. Heterogeneity between the studies was 71?% for pain and 39?% for opioid consumption (p?=?0.002 and p?=?0.0005). No major complications were reported with the use of LIA. Conclusion LIA might be able to decrease pain and the use of opioids on the first post-operative day following TKA. However, due to the high level of heterogeneity between the studies, no firm conclusions can be drawn. Level of evidence Meta-analysis, Level II.