Peer review report 3 on “Comparison of intrathecal and local infiltration analgesia by morphine for pain management in total knee and hip arthroplasty: A meta-analysis of randomised controlled trial”

Background & Objective: Local infiltration of knee joints during knee joint surgery has been used for postoperative analgesia with preservation of motor function of quadriceps muscle, which helps in early mobilization. Femoral nerve block has been incriminated with paralyses of vastus medialis muscle. We aimed to compare postoperative analgesia between femoral nerve block and local infiltration in patients undergoing unilateral total knee arthroplasty (TKA).Methodology: After obtaining institutional ethical approval and written informed consent from the patients, this randomized controlled trial was conducted at Department of Anesthesia at Teerthankar Mahaveer Medical College & Research Centre between July - December 2018. The study was conducted on 60 patients of ASA I and II, undergoing unilateral total TKA. Patients were randomly divided into two groups: Group FB patients underwent femoral nerve block, and Group LI patients underwent local infiltration analgesia. Sedation score, numeric rating scale, motor power and frequency of nausea/vomiting were recorded and statistical analysis done.Results: We observed better pain relief in patients which received femoral nerve block as compared to local infiltration analgesia (p < 0.001). Sedation score was higher in Group LI and was statistically significant between the two groups at 4th, 12th, and 48th hour (p < 0.05). Group FB patients were associated with higher muscle power grades (p < 0.001) as compared to local infiltration analgesia patients. Fentanyl demand was observed to be lesser in Group FB as compared to Group LI (p < 0.001).Conclusion: The study concludes that femoral nerve block produces better pain reliefin patients posted for unilateral knee arthroplasty as compared to local infiltration ofthe local anesthetic solution. However, there is gross reduction in range of motion withfemoral nerve block.Citation: Varshney RK, Prasad MK, Garg M. Comparison of continuous femoral nerve block with local infiltration for postoperative analgesia in unilateral total knee arthroplasty - a randomized controlled trial. Anaesth pain & intensive care 2019;23(3):268-273

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Adductor canal block combined with local infiltration analgesia versus isolated adductor canal block in reducing pain and opioid consumption after total knee arthroplasty: a systematic review and meta-analysis

Journal of International Medical Research ◽

10.1177/0300060520926075 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052092607

Author(s):

Jianyong Lv ◽

Cuiyuan Huang ◽

Zuofeng Wang ◽

Shan Ou

Keyword(s):

Total Knee Arthroplasty ◽

Meta Analysis ◽

Outcome Data ◽

Opioid Consumption ◽

Adductor Canal Block ◽

Local Infiltration Analgesia ◽

Local Infiltration ◽

Adductor Canal ◽

Total Knee ◽

Infiltration Analgesia

Objective To evaluate the efficacy and safety of the addition of local infiltration analgesia (LIA) to adductor canal block (ACB) for pain control after primary total knee arthroplasty (TKA). Methods Two reviewers independently searched for potentially relevant published studies using electronic databases, including PubMed® (1966 to June 2019), Embase® (1974 to June 2019) and Web of Science (1990 to June 2019). The results were pooled using the random-effects model to produce standard mean differences for continuous outcome data and odds ratio for categorical outcome data. Results A total of three randomized controlled trials (RCTs) and three non-RCTs were included for data extraction and meta-analysis. There were significant differences between the two groups regarding the postoperative pain score on postoperative day (POD) 0 and POD 1. The cumulative opioid consumption in the ACB plus LIA groups was significantly lower than that in the ACB groups on POD 0 and POD 1. No significant differences were found in terms of postoperative range of motion or length of hospitalization. Conclusion ACB plus LIA significantly reduced the postoperative pain score on POD 0 and POD 1 compared with isolated ACB. In addition, ACB plus LIA was associated with a significant reduction in opioid consumption during the early postoperative period.

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