Analgesic efficacy of local infiltration anaesthesia versus femoral nerve block in alleviating postoperative wound pain following total knee arthroplasty: A systematic review and meta-analysis

Abstract

Total knee arthroplasty (TKA) often involves significant postoperative pain, necessitating effective analgesia. This meta-analysis compares the analgesic efficacy of local infiltration anaesthesia (LIA) and femoral nerve block (FNB) in managing postoperative wound pain following TKA. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis was structured around the PICO framework, assessing studies that directly compared LIA and FNB in TKA patients. A comprehensive search across PubMed, Embase, Web of Science and the Cochrane Library was conducted without time restrictions. Studies were included based on specific criteria such as participant demographics, study design and outcomes like pain scores and opioid consumption. Quality assessment utilized the Cochrane Collaboration's risk of bias tool. The statistical approach was determined based on heterogeneity, with the choice of fixed- or random-effects models guided by the I² statistic. Sensitivity analysis and evaluation of publication bias using funnel plots and Egger's linear regression test were also conducted. From an initial pool of 1275 articles, eight studies met the inclusion criteria. These studies conducted in various countries from 2007 to 2016. The meta-analysis showed no significant difference in resting and movement-related Visual Analogue Scale scores post-TKA between the LIA and FNB groups. However, LIA was associated with significantly lower opioid consumption. The quality assessment revealed a low risk of bias in most studies, and the sensitivity analysis confirmed the stability of these findings. There was no significant publication bias detected. Both LIA and FNB are effective in controlling postoperative pain in TKA patients, but LIA offers the advantage of lower opioid consumption. Its simplicity, cost-effectiveness and opioid-sparing nature make LIA the recommended choice for postoperative analgesia in knee replacement surgeries.

Keywords: femoral nerve block; local infiltration anaesthesia; meta-analysis; postoperative pain management; total knee arthroplasty.

FIGURE 1

Study selection flowchart: Illustrates the detailed process of study selection for the meta‐analysis, from initial identification to final inclusion.

FIGURE 2

Risk of bias assessment: Depicts the risk of bias in included studies using the Cochrane Collaboration's tool, with colour coding representing different risk levels: high (red), unclear (yellow) and low (green).

FIGURE 3

Forest plot for resting Visual Analogue Scale (VAS) scores post‐total knee arthroplasty (TKA): Shows the meta‐analytic results of resting VAS scores in patients following TKA. CI, confidence interval.

FIGURE 4

Movement‐related Visual Analogue Scale (VAS) scores forest plot: This forest plot provides a visual representation of the comparative results for movement‐related pain VAS scores post‐total knee arthroplasty. CI, confidence interval.

FIGURE 5

Opioid consumption post‐total knee arthroplasty (TKA) forest plot: Demonstrates the differences in opioid consumption post‐TKA between the local infiltration anaesthesia and femoral nerve block groups as analysed in the meta‐analysis. CI, confidence interval.

FIGURE 6

Sensitivity analysis for resting Visual Analogue Scale (VAS) scores: Displays the outcomes of the sensitivity analysis, emphasizing the stability of the meta‐analysis results for resting VAS scores post‐total knee arthroplasty. CI, confidence interval.

FIGURE 7

Publication bias funnel plot: A funnel plot assessing the presence of publication bias in the context of resting Visual Analogue Scale scores post‐total knee arthroplasty.