Abstract
BackgroundWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of local infiltration anesthesia (LIA) versus epidural analgesia (EPA) for postoperative pain control in total knee arthroplasty (TKA).MethodsIn December 2017, a systematic computer-based search was conducted in Pubmed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared LIA versus EPA for postoperative pain control in TKA were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12, 24 and 48, and 72 h. The secondary outcomes were the range of motion, the length of stay, and the occurrence of infection and nausea. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.ResultsSeven clinical studies with 251 patients (LIA = 124, EPA = 127) were included in the meta-analysis. There was no significant difference between LIA and EPA group in terms of the VAS score with rest at 12 and 24 h. LIA was associated with a reduction of the VAS score with rest at 48 and 72 h than EPA (P < 0.05). There was no significant difference between the LIA group and EPA group in terms of the VAS with mobilization at 24, 48, and 72 h (P > 0.05). And LIA was associated with an increase of the range of motion at 24 and 48 h (P < 0.05) and a reduction of the length of hospital stay (P < 0.05). What is more, LIA was associated with a reduction of the occurrence of the nausea.ConclusionsLIA has equivalent efficacy as EPA for pain control after TKA and shows an increase of the range of motion and a reduction of the occurrence of nausea and length of hospital stay. Due to the limited number of the included studies, more high-quality RCTs are still needed to identify the long-term effects of LIA for pain control after TKA.
Highlights
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of local infiltration anesthesia (LIA) versus epidural analgesia (EPA) for postoperative pain control in total knee arthroplasty (TKA)
visual analogue scale (VAS) score with rest at 48 h were available in five studies, and pooled results indicated that LIA was associated with a reduction of the VAS score with rest at 48 h than EPA (WMD = − 1.09, 95% Confidence interval (CI) − 2.09, − 0.09, P = 0.032, Fig. 4c)
VAS score with rest at 72 h were available in five studies, and pooled results indicated that LIA was associated with a reduction of the VAS score with rest at 72 h than EPA (WMD = − 0.88, 95% CI − 1.29, − 0.46, P = 0. 000, Fig. 4d)
Summary
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of local infiltration anesthesia (LIA) versus epidural analgesia (EPA) for postoperative pain control in total knee arthroplasty (TKA). Total knee arthroplasty (TKA) is a commonly performed procedure today. More than half of the patients undergoing TKA would experience severe pain in the early postoperative period [2,3,4]. Epidural analgesia consisting of a local anesthetic agent and an opioid has been a regular regimen used for postoperative analgesia after TKA. Some studies have indicated that the benefit of epidural analgesia must be weighed against the frequency of its adverse effects such as urinary retention, hypotension, pruritus, and motor block that delays mobilization
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