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Meta-Analysis
. 2017 Sep;96(38):e8103.
doi: 10.1097/MD.0000000000008103.

Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty: A meta-analysis of randomized controlled trials

Qiujuan Xing  1 , Weiwei Dai, Dongfeng Zhao, Ji Wu, Chunshui Huang, Yun Zhao
Affiliations
Meta-Analysis

Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty: A meta-analysis of randomized controlled trials

Qiujuan Xing et al. Medicine (Baltimore). 2017 Sep.

Abstract

Background: This meta-analysis aimed to evaluate the efficiency and safety of the combined adductor canal block with peri-articular infiltration versus periarticular infiltration alone for pain control after total knee arthroplasty (TKA).

Methods: PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify articles comparing the combined adductor canal block with peri-articular infiltration and periarticular infiltration alone for pain control after TKA. Main outcomes were numeric rating scale (NRS) at postoperative day (POD) 0-2 and opioid consumption. Meta-analysis was performed using Stata 11.0 software.

Results: Four randomized controlled trial (RCTs) including 297 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between the groups regarding NRS score at POD 0 (weighted mean difference [WMD] = -0.849, 95% confidence interval [CI]: -1.345 to -0.353, P = .001), POD 1 (WMD = -0.960, 95% CI: -1.474 to -0.446, P = .000), and POD 2 (WMD = -0.672, 95% CI: -1.163 to -0.181, P = .007) after TKA. Significant differences were found in terms of opioid consumption at POD 0 (WMD = -3.761, 95% CI: -6.192 to -1.329, P = .002), POD 1 (WMD = -4.795, 95% CI: -8.181 to -1.409, P = .006), and POD 2 (WMD = -2.867, 95% CI: -4.907 to -0.827, P = .006).

Conclusion: Combined adductor canal block with peri-articular infiltration could significantly reduce NRS scores and opioid consumption in comparison with periarticular infiltration alone following TKA. Additionally, there is a lower incidence of nausea and vomiting in the combined groups.

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Conflict of interest statement

Conflicts of Interest: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Search results and the selection procedure.
Figure 2
Figure 2
Forest plot diagram showing NRS scores at POD 0 after TKA. NRS = numeric rating scale, POD = postoperative day, TKA = total knee arthroplasty, WMD = weighted mean difference.
Figure 3
Figure 3
Forest plot diagram showing NRS scores at POD 1 after TKA. NRS = numeric rating scale, POD = postoperative day, TKA = total knee arthroplasty, WMD = weighted mean difference.
Figure 4
Figure 4
Forest plot diagram showing NRS scores at POD 2 after TKA. NRS = numeric rating scale, POD = postoperative day, TKA = total knee arthroplasty, WMD = weighted mean difference.
Figure 5
Figure 5
Forest plot diagram showing opioid consumption at POD 0 after TKA. POD = postoperative day, TKA = total knee arthroplasty, WMD = weighted mean difference.
Figure 6
Figure 6
Forest plot diagram showing opioid consumption at POD 1 after TKA. POD = postoperative day, TKA = total knee arthroplasty, WMD = weighted mean difference.
Figure 7
Figure 7
Forest plot diagram showing opioid consumption at POD 2 after TKA. POD = postoperative day, TKA = total knee arthroplasty, WMD = weighted mean difference.
Figure 8
Figure 8
Forest plot diagram showing length of hospital stay after TKA. TKA = total knee arthroplasty, WMD = weighted mean difference.
Figure 9
Figure 9
Forest plot diagram showing incidence of nausea after TKA. TKA = total knee arthroplasty.
Figure 10
Figure 10
Forest plot diagram showing incidence of vomiting after TKA. TKA = total knee arthroplasty.
Figure 11
Figure 11
Forest plot diagram showing incidence of constipation after TKA. TKA = total knee arthroplasty.
Figure 12
Figure 12
Forest plot diagram showing incidence of pruritus after TKA. TKA = total knee arthroplasty.
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