Background: Total knee arthroplasty (TKA) is one of the most commonly performed procedures
while postoperative analgesia still remains challenging. The efficacy and safety of local infiltration
analgesia (LIA) versus regional blockade (RB; epidural analgesia and/or peripheral nerve block) for
pain management after TKA are controversial.
Objectives: The purpose of this meta-analysis was to determine whether LIA compared with RB
would provide better postoperative pain control, consume less morphine, facilitate early functional
recovery, entail a differential risk of side effects and complications, and allow a shorter length of
stay.
Study Design: This meta-analysis pooled all data published in randomized controlled trials (RCTs)
examining the efficacy and safety of LIA versus RB following TKA.
Setting: The work was performed at Affiliated Cixi Hospital, Wenzhou Medical University.
Methods: Literature in English was searched using EMBASE, Medline, Cochrane Library, CINAHL,
Web of Science, and Scopus from inception to April 2015. RCTs that compared LIA and RB for
postoperative analgesia following TKA were included. Methodological quality was assessed using
the Cochrane Back Review Group checklist, and a sensitivity analysis was performed. Sixteen RCTs
with a total of 1,206 patients were finally included in our study.
Results: The results of our meta-analysis indicate that patients managed by LIA showed
significantly lower numeric rating scale (NRS) score at rest (WMD: -0.40 [-0.72, -0.07]; P = 0.02)
when compared with those managed by RB. Difference of morphine consumption was not
significant (WMD: -1.39 [-7.21, 4.44]; P = 0.64) between the 2 groups. In terms of early functional
recovery, the LIA group showed more straight leg raise (RR: 2.90 [2.15, 3.93]; P < 0.00001) on
the first postoperative day; better range of motion within one week (WMD: 4.33 [2.61, 6.05];
P < 0.00001), but not at 3 months (WMD: 1.98 [-0.02, 3.98]; P = 0.05); and comparable knee
society score (WMD: -8.79 [-27.05, 9.48]; P = 0.35). Length of hospital stay of the LIA group was
marginally shorter (WMD: -0.25 [-0.49, -0.01]; P = 0.05) than that of the RB group. Risk of side
effects and complications were comparable between groups.
Limitations: The lack of a standard criterion regarding the technique details of LIA and
heterogeneity resulting from the various analgesic components, dosages, and different
administration methods might have posed a bias on the results.
Conclusion: Our results have indicated that LIA provided better analgesia than RB at rest and
preserved quadriceps function in the immediate postoperative period, which may be beneficial to
early functional recovery. And its safety profile is reliable. With the biases in our meta-analysis, a
rigorous and adequately powered RCT is needed to validate our results.
Key words: Local infiltration analgesia, regional block, peripheral nerve block, epidural analgesia,
postoperative analgesia, total knee arthroplasty, meta-analysis, randomized controlled trial
Local Infiltration Analgesia Versus Regional
Blockade for Postoperative Analgesia in
Total Knee Arthroplasty: A Meta-analysis of
Randomized Controlled Trials
