A meta-analysis on advantages of peripheral nerve block post-total knee arthroplasty

Abstract

Background: Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions.

Methods: We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices.

Conclusions: Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

Keywords: Analgesia; Analgesics; Arthroplasty; Epidural; Evidence-Based Medicine; Femoral Nerve; Knee; Meta-Analysis; Nerve Block; Opioid; Pain; Pain Management; Postoperative.; Replacement.

Fig. 1

Flowchart of the study selection process.

Fig. 2

Risk of bias graph and summary.

Fig. 3

Forest plot for the incidence of nausea and vomiting after nerve block vs. epidural block. M-H: Mantel-Haenszel, CI: confidence interval, df: degree of freedom.

Fig. 4

Forest plot for the incidence of hypotension after nerve block vs. epidural block. M-H: Mantel-Haenszel, CI: confidence interval, df: degree of freedom.

Fig. 5

Forest plot for the incidence of urinary retention after nerve block vs. epidural block. M-H: Mantel-Haenszel, CI: confidence interval, df: degree of freedom.

Fig. 6

Forest plot for the incidence of pruritus after nerve block vs. epidural block. M-H: Mantel-Haenszel, CI: confidence interval, df: degree of freedom.

Fig. 7

Forest plot for the incidence of sedation after nerve block vs. epidural block. M-H: Mantel-Haenszel, CI: confidence interval, df: degree of freedom.

Fig. 8

Forest plot for the visual analogue scale score during 0-12 hours after surgery after nerve block vs. epidural block. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

Fig. 9

Forest plot for the visual analogue scale score within 12-24 horrs after nerve block vs. epidural analgesia. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

Fig. 10

Forest plot for the sensitivity analyses (24-48 hr). SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

Fig. 11

Forest plot for patient satisfaction after nerve block vs. epidural block. M-H: Mantel-Haenszel, CI: confidence interval, df: degree of freedom.

Fig. 12

Forest plot for intraoperative opioid use. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

Fig. 13

Forest plot for sensitivity analyses of the length of hospital stay. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.

Fig. 14

Forest plot for active knee flexion after nerve block vs. epidural analgesia. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom.