Continuous nerve block versus single-shot nerve block for total knee arthroplasty: a meta-analysis from randomized controlled trials.

Abstract

This meta-analysis aims to determine whether continuous nerve block (CNB) provides better pain relief and functional recovery than single-shot nerve block (SSNB) after total knee arthroplasty (TKA). Embase, PubMed, and the Cochrane Library databases were comprehensively searched. Randomized controlled trials (RCTs) with a modified Jadad Score ≥4 comparing CNB with SSNB in patients after TKA were enrolled in our meta-analysis. The primary outcomes were visual analogue scale (VAS) pain score and morphine consumption. The secondary outcomes were distance able to ambulate, complications and length of hospital stay. Review Manager 5.3 for Windows was used to analyze the extracted data. Two RCTs that compared continuous adductor canal block (ACB) with single-shot ACB, and four RCTs that compared continuous femoral nerve block (FNB) with single-shot FNB were included in our meta-analysis. There were no significant differences in VAS scores at rest for 12 hours (P=0.44), 24 hours (P=0.15) and 48 hours (P=0.16) postoperatively, VAS scores on activity for 24 hours (P=0.15) and 48 hours (P=0.23), total opioid consumption at 12 hours (P=0.20), 24 hours (P=0.25) and 48 hours (P=0.41), distance walked at 24 hours (P=0.58) and 48 hours (P=0.93), nausea and vomiting at 24 hours (P=0.18) and 48 hours (P=0.62), and length of hospital stay (P=0.71) between the CNB and SSNB groups. CNB and SSNB have similar effects on pain relief, complications and functional recovery in patients receiving TKA. The optimal analgesic regimen for patients after TKA needs further identification.