Surgical Anesthesia Center, The First People's Hospital of Longquanyi District, Chendu 610100, China.
Surgical Anesthesia Center, The First People's Hospital of Longquanyi District, Chendu 610100, China; Department of Anesthesia, West China Hospital, Sichuan University, Chengdu 610000, China.
J Perianesth Nurs. 2021 Aug;36(4):406-412. doi: 10.1016/j.jopan.2020.10.015. Epub 2021 Mar 10.
Local infiltration analgesia, an essential component of multimodal analgesia after total knee arthroplasty (TKA), can be classified into periarticular injection (PAI) and intra-articular injection (IAI) as per administration techniques. Currently, there is no definite answer of the optimal choice between the two techniques. This meta-analysis aims to determine whether PAI provides superiority of pain relief and functional recovery than IAI after TKA.
Systematic review and meta-analysis.
Comparative studies that compared PAI and IAI in patients after TKA were searched in the Embase, PubMed, MEDLINE, and the Cochrane Library databases. The primary outcomes were visual analog scale scores for pain and opioid consumption. The secondary outcomes were complications, function of recovery, and length of hospital stay.
Four randomized controlled trials and two case-controlled studies with a total of 769 patients were enrolled. There were no significant differences in mean visual analog scale scores at postoperative day 0 (P = .17) and day 1 (P = .27), maximum visual analog scale scores at day 0 (P = .89) and day 1 (P = .82), total opioid consumption at day 1 (P = .96), opioid complications (P = .15), and length of hospital stay (P = .84) between PAI and IAI.
Based on the available evidence, PAI does not offer superior effects at pain control and discharge than IAI after TKA. However, owing to the limited sample size and heterogeneity of the included studies, further large well-designed randomized controlled trials are still needed to validate this conclusion.
The protocol has been registered in the PROSPERO international database under number CRD42020165138.
局部浸润镇痛是全膝关节置换术（TKA）后多模式镇痛的重要组成部分，根据给药技术可分为关节周围注射（PAI）和关节内注射（IAI）。目前，两种技术之间的最佳选择尚无明确答案。本荟萃分析旨在确定 TKA 后 PAI 是否比 IAI 具有更好的缓解疼痛和功能恢复效果。
系统评价和荟萃分析。
在 Embase、PubMed、MEDLINE 和 Cochrane 图书馆数据库中搜索比较 TKA 后接受 PAI 和 IAI 的患者的对照研究。主要结局指标为疼痛和阿片类药物消耗的视觉模拟评分。次要结局指标为并发症、恢复功能和住院时间。
共纳入 4 项随机对照试验和 2 项病例对照研究，共 769 例患者。术后第 0 天（P=0.17）和第 1 天（P=0.27）的平均视觉模拟评分、第 0 天（P=0.89）和第 1 天（P=0.82）的最大视觉模拟评分、第 1 天的总阿片类药物消耗（P=0.96）、阿片类药物并发症（P=0.15）和住院时间（P=0.84）在 PAI 和 IAI 之间无显著差异。
根据现有证据，PAI 在 TKA 后控制疼痛和出院方面的效果并不优于 IAI。然而，由于纳入研究的样本量有限且存在异质性，仍需要进一步开展大型设计良好的随机对照试验来验证这一结论。
该方案已在 PROSPERO 国际数据库中注册，编号为 CRD42020165138。
