Department of Orthopedics, Jianhu People's Hospital of Jiangsu Province, Yancheng, Jiangsu, China.
Clin J Pain. 2018 Nov;34(11):1047-1060. doi: 10.1097/AJP.0000000000000631.
The severe pain after total knee arthroplasty (TKA) brings many patients more suffering, longer hospital stay, and higher expenses. This study was designed to assess the relative efficacy of several clinical treatments for postoperative analgesia of TKA through network meta-analysis based on multiple published randomized controlled trials.
Embase and PubMed were utilized to conduct this network meta-analysis from inception until 2016. Pain score, morphine consumption (milligrams), and length of hospitalization (day) were selected as the endpoints.
A total of 58 studies with 3501 patients were included in this network meta-analysis. Except for patient-controlled epidural analgesia+femoral nerve block (FNB) and sciatic nerve block, all treatments were significantly superior to placebo in pain score 6 to 8 hours. In terms of pain score 24 hours, only continuous femoral nerve block (cFNB), periarticular infiltration, periarticular infiltration+FNB, single-dose FNB, and sciatic nerve block+FNB exhibited better performance than control group. For pain score 48 hours after surgery, only cFNB and intra-articular infiltration yielded better results than control group [standard mean difference=-0.68, 95% credible intervals (CrIs)=-1.03 to -0.33; standard mean difference=-0.53, 95% CrIs=-1.07 to -0.01, respectively]. Only cFNB exhibited better results with respect to morphine consumption day 2 after surgery (mean difference=-12.95, 95% CrIs=-19.70 to -6.53).
Considering both pain score and morphine consumption, cFNB was potentially the most efficacious postoperative treatment for patients undergoing TKA.
全膝关节置换术后（TKA）的严重疼痛给许多患者带来了更多的痛苦、更长的住院时间和更高的费用。本研究旨在通过基于多个已发表的随机对照试验的网络荟萃分析来评估几种 TKA 术后镇痛临床治疗方法的相对疗效。
从创建到 2016 年，我们在 Embase 和 PubMed 上进行了这项网络荟萃分析。疼痛评分、吗啡消耗量（毫克）和住院时间（天）被选为终点。
共有 58 项研究，涉及 3501 例患者，被纳入本网络荟萃分析。除了患者自控硬膜外镇痛+股神经阻滞（FNB）和坐骨神经阻滞外，所有治疗方法在术后 6-8 小时的疼痛评分方面均明显优于安慰剂。在术后 24 小时的疼痛评分方面，只有连续股神经阻滞（cFNB）、关节周围浸润、关节周围浸润+FNB、单次 FNB 和坐骨神经阻滞+FNB 与对照组相比表现更好。在术后 48 小时的疼痛评分方面，只有 cFNB 和关节内浸润的结果优于对照组[标准均数差（SMD）=-0.68，95%可信区间（CrI）=-1.03 至-0.33；SMD=-0.53，95% CrI=-1.07 至-0.01]。只有 cFNB 在术后第 2 天的吗啡消耗量方面表现更好（平均差=-12.95，95% CrI=-19.70 至-6.53）。
考虑到疼痛评分和吗啡消耗量，cFNB 可能是 TKA 术后最有效的治疗方法。
