The efficacy of intraoperative periarticular injection in Total hip arthroplasty: a systematic review and meta-analysis

Hsuan-Hsiao Ma, Te-Feng Arthur Chou, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, Wei-Ming Chen, Hsuan-Hsiao Ma, Te-Feng Arthur Chou, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, Wei-Ming Chen

Abstract

Background: Periarticular injection (PAI) is a regional analgesia method performed in total hip arthroplasty (THA) for postoperative pain relief. However, its efficacy and safety is still inconclusive. Therefore, we conducted this meta-analysis to assess the safety of PAI and to determine if PAI provides better pain relief and reduce the consumption of opioids after THA.

Methods: We searched PubMed, Web of Science, Embase and the Cochrane Library comprehensively. Only randomized control trials were included in our meta-analysis. Eleven studies that compared the efficacy of PAI with the control group were included. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and Jadad score were applied to assess the quality of the included studies. We used the recommendations by the Cochrane Collaboration to reduce bias and to ensure our results were reliable and veritable.

Results: Our analysis demonstrated that PAI was more effective than the control group with a lower visual analog scale (VAS) score during rest at 24 h (P = 0.003), 48 h (P = 0.002), and VAS score with activity at 24 h (P = 0.04). There was also less amount of opioid consumption (P = 0.01). There were no differences in length of hospital stay (P = 0.526) and postoperative nausea rate (P = 0.153).

Conclusion: Compared with the control group, PAI showed better pain relief and less amount of opioid consumption after THA. Our meta-analysis suggests that PAI is a safe and effective multimodal analgesia technique that can be used for THA.

Keywords: Local infiltration analgesics; Pain management; Periarticular injection; Total hip arthroplasty.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow diagram for the searching and identification of included studies
Fig. 2
Fig. 2
The effect of periarticular injection (PAI) on VAS score during rest at 24 h as compared with control group
Fig. 3
Fig. 3
The effect of periarticular injection (PAI) on VAS score with activity at 24 h as compared with control group
Fig. 4
Fig. 4
The effect of periarticular injection (PAI) on VAS score during rest at 48 h as compared with control group
Fig. 5
Fig. 5
The effect of periarticular injection (PAI) on amount of opioid consumption at 24 h as compared with control group
Fig. 6
Fig. 6
The effect of periarticular injection (PAI) on length of hospital stay at 24 h as compared with control group
Fig. 7
Fig. 7
The effect of periarticular injection (PAI) on post-operative nausea at 24 h as compared with control group
Fig. 8
Fig. 8
Summary of the assessment of the risk of bias
Fig. 9
Fig. 9
Results of risk of bias evaluation for each study according to the recommendations of the Cochrane Collaboration

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Source: PubMed

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