• Thomas Osinski, Samir Bekka, Jean-Philippe Regnaux, Dominique Fletcher, and Valeria Martinez.
• From the Service d'anesthésie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris (SB, DF, VM), INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur (TO, DF, VM), Université Versailles Saint-Quentin, Paris (DF, VM) and Département sciences infirmières et paramédicales Ecole des Hautes Etudes en santé publique, Rennes, France (J-PR).
• Eur J Anaesthesiol. 2019 Jun 1; 36 (6): 418-426.

BackgroundRegional analgesia (RA) has been widely evaluated for pain relief after total knee arthroplasty (TKA). Its impact on functional recovery is less well known.ObjectivesTo evaluate the functional benefits of RA after TKA.DesignSystematic review with a random-effects meta-analysis of randomised controlled trials comparing LRA with systemic analgesia on function in adults undergoing TKA for osteoarthritis.Database SourcesMEDLINE, EMBASE, LILAC, Cochrane, CTRD databases.OutcomesLength of stay (LOS) in hospital and early knee flexion range of motion (ROM), early and long-term knee function, serious adverse effects.ResultsTwenty-three studies (1246 patients) were included. LOS was significantly shorter for RA than for systemic analgesia (0.90 days, 95% confidence interval 0.3 to 1.4). Subgroup analyses found that only infiltration analgesia decreased the LOS. ROM during the first week was significantly higher for all techniques of RA than for systemic analgesia (9.23°, 95% confidence interval 4.6 to 13.9). No impact of regional analgesia techniques on global function in the longer term was demonstrated. No difference in serious adverse effects was found between RA and systemic analgesia.ConclusionRA techniques compared with systemic analgesia have a beneficial impact on the LOS and the ROM achieved in the early postoperative period. Global function in the longer term after surgery seems unaffected by peri-operative RA.Trial RegistrationCRD42014013995.

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