Impact of regional and local anaesthetics on length of stay in knee arthroplasty

Background: Regional and local anaesthetic techniques are thought to improve postoperative pain control and functional outcomes following total knee arthroplasty, potentially leading to a reduction in hospital length of stay. Objectives: The objective of this study was to evaluate the reporting quality and discuss the clinical findings of the available literature on these modalities that included length of stay as a study outcome. Data sources: The electronic databases Pubmed, Scopus, Medline, Web of Science and Cochrane library were searched using key words. Review methods: Eight-hundred and forty-three papers were identified in the search. Fifteen of these met the inclusion criteria. Eight further studies were identified from their reference lists to give a final total of 23 studies that were reported against the consolidated standards of reporting trials (CONSORT) 2001 statement checklist. Results: The mean criteria CONSORT score was 17.3/ 22 (79%). The majority of studies that compared femoral nerve blocks with placebo or conventional pain management modalities failed to demonstrate a significant reduction in length of stay. All studies that compared femoral nerve blocks with epidurals found no significant difference in length of stay. Only half of the studies comparing local anaesthetic techniques to placebo or conventional pain management methods found a significant reduction in length of stay. Conclusions: The reporting quality has specific deficiencies in the areas of sample size calculation, randomization whilst there was under-reporting of blinding. Regional and local anaesthetic techniques have not demonstrated a clear reduction in hospital length of stay. Epidurals and femoral nerve blocks have similar impacts on length of stay.