Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

Chen Li, Ji Qu, Su Pan, Yang Qu, Chen Li, Ji Qu, Su Pan, Yang Qu

Abstract

Background: 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).

Methods: In 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.

Results: Seven 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.

Conclusions: LIA 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.

Keywords: Local infiltration anesthesia; Meta-analysis; Pain control; Total knee arthroplasty.

Conflict of interest statement

Ethics approval and consent to participate

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flowchart of study search and inclusion criteria
Fig. 2
Fig. 2
Risk of bias summary of included randomized controlled trials. +, no bias; −, bias; ?, bias unknown
Fig. 3
Fig. 3
The risk of bias graph
Fig. 4
Fig. 4
Forest plots of the included studies comparing the VAS with rest at 12 h (a), 24 h (b), 48 h (c), and 72 h (d)
Fig. 5
Fig. 5
Forest plots of the included studies comparing the VAS with mobilization at 24 h (a), 48 h (b), and 72 h (c)
Fig. 6
Fig. 6
Forest plots of the included studies comparing the range of motion at 24, 48, and 72 h
Fig. 7
Fig. 7
Forest plots of the included studies comparing the length of hospital stay between the two groups
Fig. 8
Fig. 8
Forest plots of the included studies comparing the occurrence of nausea between the two groups
Fig. 9
Fig. 9
Forest plots of the included studies comparing the occurrence of infection between the two groups
Fig. 10
Fig. 10
Funnel plot that comparing the VAS with rest at 12, 24, 48, and 72 h
Fig. 11
Fig. 11
Sensitivity analysis of the VAS with rest at 12 h

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