• Yang Cui, Tuo Yang, Chao Zeng, Jie Wei, Xi Xie, Liangjun Li, Xiang Ding, Yi Zhang, and Guanghua Lei.
• Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
• BMJ Open. 2016 Jul 12; 6 (7): e011325.

ObjectivesTo evaluate the efficacy and safety of intra-articular (IA) bupivacaine administered for pain relief after joint arthroplasty.DesignMeta-analysis.MethodsA systematic review was conducted to identify the randomised controlled trials using IA bupivacaine for postoperative pain relief from MEDLINE, Cochrane Library and EMBASE databases (up to October 2015). The standardised mean difference (SMD), the relative risk (RR) and their corresponding 95% CIs were calculated using the RevMan statistical software.ResultsA total of 11 randomised controlled trials were included. Statistically significant differences between IA bupivacaine and placebo were observed for the mean visual analogue scale (VAS) values (SMD -0.55; 95% CI -0.89 to -0.22; p<0.001) and narcotic consumption (SMD -0.32; 95% CI -0.55 to -0.08; p=0.008) during the period of 24 hours postoperatively and narcotic consumption during the period between 24 and 48 hours postoperatively (SMD -0.32; 95% CI -0.55 to -0.08; p=0.009). However, there was no significant difference in the mean VAS pain score during the period between 24  and 48 hours postoperatively (SMD -0.09, 95% CI -0.30 to 0.11; p=0.37) and in the incidence of adverse effects 24-72 hours postoperatively (RR 0.97; 95% CI 0.60 to 1.57; p=0.91).ConclusionsThe administration of IA bupivacaine after joint arthroplasty is effective for pain relief without increasing adverse effects.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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