Comparisons between perioperative continuous femoral nerve block and patient controlled analgesia for analgesia in primary total knee arthroplasty: a Meta-analysis

Abstract

Objective To evaluate the efficacy and safety of continuous femoral nerve block (CFNB) versus patient controlled analgesia (PCA) for analgesia in primary total knee arthroplasty (TKA) through a Meta-analysis. Methods All randomized controlled trials (RCTs) which compared about the efficacy and safety of CFNB versus PCA for analgesia in primary TKA, were searched from Cochrane Library, Embase, PubMed, CBM, VIP, Wang Fang database and CNKI. At the same time, conference papers were identified manually. A quality assessment of the included literature was evaluated by Cochrane system evaluation manually. Revman 5.3 software was used for the Meta-analysis to compare visual analogue scale(VAS), hospital for special surgery knee score (HSS), western Ontario and McMaster university of orthopedic index (WOMAC), patient satisfactory degree, and incidences of complications (nausea, vomit, dizziness, somnolence, itch of skin, etc). Results Twenty-four RCTs involving 1896 patients were identified including CFNB (946 cases) and PCA (950 cases) application of TKA. The pooled results illustrated that CFNB could reduce VAS in rest (MD=-1.28, 95%CI-1.56, -1.00, P<0.05) and VAS in movement (MD=-0.98, 95%CI-1.38, -0.58, P<0.05), increase HSS (MD=2.13, 95%CI 0.12, 4.14, P<0.05), reduce WOMAC(MD=-0.97, 95%CI-1.83, -0.11, P<0.05), increase patient satisfactory degree (RR=1.27, 95%CI 1.10, 1.46, P<0.05) and at the same time reduce the incidences of nausea, vomit, dizziness, somnolence and itch of skin (RR=0.32, 95%CI 0.24, 0.43, P<0.05). Conclusion Compared with PCA, CFNB analgesia can reduce VAS, WOMAC score, improve the postoperative HSS and patient satisfaction degree, and decrease the risk of complications. Key words: Arthroplasty, replacement, knee; Randomized controlled trial; Analgesia; Meta-analysis