Intrathecal versus local infiltration analgesia for pain control in total joint arthroplasty

Ai-Lan Cai,Bin Wu,Sheng-Jie Liu,Geng Liu

doi:10.1186/s13018-020-01627-4

Ai-Lan Cai, Bin Wu + Show 2 more

Open Access

https://doi.org/10.1186/s13018-020-01627-4

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Abstract

BackgroundThe purpose of this meta-analysis was to assess the efficacy of intrathecal morphine (ITM) analgesia and local infiltration analgesia (LIA) for pain control in total joint arthroplasty (TJA).MethodsEmbase, PubMed, the Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs). All RCTs were comparing intrathecal analgesia and local infiltration analgesia in TJA. Primary outcomes were the visual analog scale (VAS) score with rest or mobilization up to 72 h. Secondary outcomes were the total morphine consumption, length of hospital stay, and morphine-related complications.ResultsCompared with the intrathecal analgesia group, the LIA group was associated with a reduction in VAS score with rest up to 72 h. Moreover, LIA was associated with a decrease in VAS score with mobilization at 6 h, 12 h, 48 h, and 72 h. Moreover, LIA significantly reduced total morphine consumption (weighted mean difference (WMD) = − 15.37, 95% CI − 22.64 to − 8.83, P = 0.000), length of hospital stay (WMD = − 1.39, 95% CI − 1.67 to − 1.11, P = 0.000), and morphine-related complications (nausea and pruritus).ConclusionsLocal infiltration provided superior analgesia and morphine-sparing effects within the first 72 h compared with ITM following TJA.

Highlights

Total joint arthroplasty (TJA) mainly includes total knee arthroplasty (TKA) and total hip arthroplasty (THA)
Effective pain control after total joint arthroplasty (TJA) could increase patient satisfaction and decrease the economic costs caused by the length of hospital stay [5, 6]
Compared with the intrathecal morphine (ITM) group, the local infiltration analgesia (LIA) group was associated with a reduction in visual analog scale (VAS) score with rest at 12 h (WMD = − 10.48, 95% CI − 16.25 to − 4.72, P = 0.004; Fig. 4), 24 h (WMD = − 7.63, 95% CI − 10.87 to − 4.39, P = 0.000; Fig. 4), 48 h (WMD = − 6.30, 95% CI − 11.55 to − 1.05, P = 0.019; Fig. 4), and 72 h (WMD = − 5.97, 95% CI − 9.09 to − 2.86, P = 0.000; Fig. 4)

Summary

Introduction

Total joint arthroplasty (TJA) mainly includes total knee arthroplasty (TKA) and total hip arthroplasty (THA). Effective pain control is crucial for early ambulation and good functional outcomes [4]. Ambulation can lead to accelerated rehabilitation and a shortened length of hospital stay, which are the essential elements of a fasttrack recovery program. Effective pain control after TJA could increase patient satisfaction and decrease the economic costs caused by the length of hospital stay [5, 6]. The purpose of this meta-analysis was to assess the efficacy of intrathecal morphine (ITM) analgesia and local infiltration analgesia (LIA) for pain control in total joint arthroplasty (TJA)

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Conclusion