• Clin J Pain · Nov 2018

    Review Meta Analysis Comparative Study

    Comparison of the Efficacy of Different Analgesia Treatments for Total Knee Arthroplasty: A Network Meta-Analysis.

    • Peilong Dong, Xiaobo Tang, Rongrong Cheng, and Jian Wang.
    • Department of Orthopedics, Jianhu People's Hospital of Jiangsu Province, Yancheng, Jiangsu, China.
    • Clin J Pain. 2018 Nov 1; 34 (11): 1047-1060.

    Background And AimThe 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.MethodsEmbase 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.ResultsA 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).ConclusionsConsidering both pain score and morphine consumption, cFNB was potentially the most efficacious postoperative treatment for patients undergoing TKA.

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