Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review
Open Access
- 17 June 2014
- journal article
- review article
- Published by Elsevier BV in British Journal of Anaesthesia
- Vol. 113 (3), 360-374
- https://doi.org/10.1093/bja/aeu155
Abstract
In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate the analgesic efficacy of LIA for early postoperative pain treatment. In addition, the analgesic efficacy of wound catheters and implications for length of hospital stay (LOS) were evaluated. Twenty-seven randomized controlled trials in 756 patients operated on with THA and 888 patients operated on with TKA were selected for inclusion in the review. In THA, no additional analgesic effect of LIA compared with placebo was reported in trials with low risk of bias when a multimodal analgesic regimen was administered perioperatively. Compared with intrathecal morphine and epidural analgesia, LIA was reported to have similar or improved analgesic efficacy. In TKA, most trials reported reduced pain and reduced opioid requirements with LIA compared with a control group treated with placebo/no injection. Compared with femoral nerve block, epidural or intrathecal morphine LIA provided similar or improved analgesia in the early postoperative period but most trials had a high risk of bias due to different systemic analgesia between groups. Overall, the use of wound catheters for postoperative administration of local anaesthetic was not supported in the included trials, and LOS was not related to analgesic efficacy. Despite the many studies of LIA, final interpretation is hindered by methodological insufficiencies in most studies, especially because of differences in use of systemic analgesia between groups. However, LIA provides effective analgesia in the initial postoperative period after TKA in most randomized clinical trials even when combined with multimodal systemic analgesia. In contrast, LIA may have limited additional analgesic efficacy in THA when combined with a multimodal analgesic regimen. Postoperative administration of local anaesthetic in wound catheters did not provide additional analgesia when systemic analgesia was similar and LOS was not related to use of LIA with a fast-track set-up.Keywords
This publication has 54 references indexed in Scilit:
- Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?Clinical Orthopaedics and Related Research, 2012
- Why still in hospital after fast-track hip and knee arthroplasty?Acta Orthopaedica, 2011
- Intraarticular vs. extraarticular ropivacaine infusion following high-dose local infiltration analgesia after total knee arthroplastyActa Orthopaedica, 2011
- High-volume infiltration analgesia in bilateral hip arthroplastyActa Orthopaedica, 2011
- No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplastyActa Orthopaedica, 2011
- Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral blockActa Orthopaedica, 2011
- The Association Between Lower Extremity Continuous Peripheral Nerve Blocks and Patient Falls After Knee and Hip ArthroplastyAnesthesia & Analgesia, 2010
- A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplastyActa Orthopaedica, 2010
- The Efficacy of Periarticular Multimodal Drug Infiltration in Total Hip ArthroplastyClinical Orthopaedics and Related Research, 2010
- Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplastyActa Orthopaedica, 2010