Comparison of local infiltration analgesia and sciatic nerve block for pain control after total knee arthroplasty: a systematic review and meta-analysis

Abstract

Background: This meta-analysis aimed to perform a meta-analysis to evaluate the efficiency and safety between local infiltration analgesia (LIA) and sciatic nerve block (SNB) when combined with femoral nerve block (FNB) after total knee arthroplasty (TKA).

Methods: A systematic search was performed in MEDLINE (1966-2017.04), PubMed (1966-2017.04), Embase (1980-2017.04), ScienceDirect (1985-2017.04), and the Cochrane Library. Only high-quality studies were selected. Meta-analysis was performed using Stata 11.0 software.

Results: Four randomized controlled trials (RCTs) and two non-randomized controlled trials (non-RCTs), including 273 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 12 h (SMD = -0.303, 95% CI -0.543 to -0.064, P = 0.013), VAS score at 24 h (SMD = -0.395, 95% CI -0.636 to -0.154, P = 0.001), morphine equivalent consumption at 24 h (SMD = -0.395, 95% CI -0.636 to -0.154, P = 0.001), and incidence of nausea (RD = 0.233, 95% CI 0.107 to 0.360, P = 0.000) and vomiting (RD = 0.131, 95% CI 0.025 to 0.237, P = 0.015).

Conclusion: FNB-combined SNB provides superior pain relief and less morphine consumption within the first 24 h compared FNB-combined LIA in total knee arthroplasty. In addition, there were fewer side effects associated with SNB. Because the sample size and the number of included studies were limited, a multicenter RCT is needed to identify the effects of the two kinds of methods and further work must include range of motion analyses and functional test.

Keywords: Local infiltration analgesia; Meta-analysis; Pain control; Sciatic nerve block; Total knee arthroplasty.

Fig. 1

Search results and the selection procedure

Fig. 2

Methodological quality of the randomized controlled trials

Fig. 3

Risk of bias

Fig. 4

Forest plot diagram showing VAS scores at 12 h following TKA

Fig. 5

Forest plot diagram showing VAS scores at 24 h following TKA

Fig. 6

Forest plot diagram showing VAS scores at 48 h following TKA

Fig. 7

Forest plot diagram showing morphine consumption at 24 h following TKA

Fig. 8

Forest plot diagram showing morphine consumption at 48 h following TKA

Fig. 9

Forest plot diagram showing length of stay following TKA

Fig. 10

Forest plot diagram showing incidence of nausea following TKA

Fig. 11

Forest plot diagram showing incidence of vomiting following TKA