Local infiltration analgesia following total knee arthroplasty: effect on post-operative pain and opioid consumption-a meta-analysis

被引:19
|
作者
Keijsers, Renee [1 ]
van Delft, Rogier [2 ]
van den Bekerom, Michel P. J. [3 ]
de Vries, Dirk C. A. A. [4 ]
Brohet, Richard M. [5 ]
Nolte, Peter A. [1 ]
机构
[1] Spaarne Hosp, Dept Orthopaed Surg, NL-2130 AT Hoofddorp, Netherlands
[2] Leids Univ, Dept Anesthesiol, Med Ctr, NL-2300 RC Leiden, Netherlands
[3] OLVG, Dept Orthopaed Surg, NL-1090 HM Amsterdam, Netherlands
[4] Spaarne Hosp, Dept Anesthesiol, NL-2130 AT Hoofddorp, Netherlands
[5] Spaarne Hosp, Res Ctr Linnaeus Insititute, NL-2130 AT Hoofddorp, Netherlands
关键词
Knee arthroplasty; Analgesia; Post-operative pain; Meta-analysis; DOUBLE-BLIND; MORPHINE CONSUMPTION; WOUND INFILTRATION; MANAGEMENT; EFFICACY; SURGERY; PLACEBO; TRIAL; ROPIVACAINE; BUPIVACAINE;
D O I
10.1007/s00167-013-2788-1
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Local infiltration analgesia (LIA) is a popular method for decreasing post-operative pain after total knee arthroplasty (TKA). The goal of this meta-analysis is to compare the effect of LIA with placebo on the intensity of post-operative pain and the consumption of opioids. A search was performed in the PubMed/MEDLINE, Cochrane, EMBASE and TRIP databases. All (quasi)-randomized controlled trials (RCTs) were included. LIA consists of intra-operative infiltration with at least one analgesic component. Data were pooled using Cochrane software. Seven placebo-controlled RCTs were included, involving 405 TKAs. On the first post-operative day, LIA provides an average decrease in VAS scores at rest of 12.3 % compared to placebo. Six RCTs studied opioid consumption in patients following TKA. There was a decrease in opioid consumption of 14.8 % compared to placebo 24 h after surgery. This suggests a reduced pain perception due to LIA. On the second post-operative day, the effect on both outcome measures was diminished and no longer significant. Heterogeneity between the studies was 71 % for pain and 39 % for opioid consumption (p = 0.002 and p = 0.0005). No major complications were reported with the use of LIA. LIA might be able to decrease pain and the use of opioids on the first post-operative day following TKA. However, due to the high level of heterogeneity between the studies, no firm conclusions can be drawn. Meta-analysis, Level II.
引用
收藏
页码:1956 / 1963
页数:8
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