Liposomal bupivacaine infiltration versus femoral nerve block for pain control in total knee arthroplasty: A systematic review and meta-analysis

医学 科克伦图书馆 荟萃分析 恶心 关节置换术 随机对照试验 股神经阻滞 全膝关节置换术 内收肌管 麻醉 不利影响 股神经 呕吐 布比卡因 神经阻滞 外科 内科学
作者
Jianbing Ma,Weijie Zhang,Shuxin Yao
出处
期刊:International Journal of Surgery [Wolters Kluwer]
卷期号:36: 44-55 被引量:40
标识
DOI:10.1016/j.ijsu.2016.10.007
摘要

Total knee arthroplasty (TKA) usually results in postoperative pain. The objective of this meta-analysis was to compare the effectiveness and safety of liposomal bupivacaine (LB) infiltration and femoral nerve block (FNB) for pain control in total knee arthroplasty. We systemically searched electronic databases, including Embase (1980–2016.7), MEDLINE (1966–2016.7), PubMed (1966–2016.7), ScienceDirect (1985–2016.7), Web of Science (1950–2016.7) and Cochrane Library for potentially relevant articles. All calculations were conducted using Stata 11.0. One randomized controlled trials (RCTs) and five non-RCTs involving 1289 participants met the inclusion criteria. The result of the meta-analysis revealed that there were no significant differences in terms of postoperative pain scores at POD 0 (SMD = −0.047, 95% CI: -0.276 to 0.182, P = 0.688), POD1 (SMD = −0.038, 95% CI: -0.273 to 0.197, P = 0.749) or POD 2 (SMD = −0.043, 95% CI: -0.192 to 0.107, P = 0.575). Significant differences were found between groups in morphine equivalent consumption at POD 1 (SMD = 0.625, 95% CI: 0.068 to 1.183, P = 0.028) and POD 2 (SMD = 0.410, 95% CI: 0.024 to 0.796, P = 0.037) between groups. There were no significant differences regarding the incidence of adverse effects such as nausea (RD = −0.01, 95% CI: -0.04 to −0.075, P = 0.914) or vomiting (RD = 0.006, 95% CI: -0.049 to 0.062, P = 0.821). Liposomal bupivacaine infiltration provides similar postoperative pain relief to femoral nerve block following total knee arthroplasty. In addition, liposomal bupivacaine infiltration could significantly reduce the consumption of morphine equivalents compared to femoral nerve block without an increased risk of adverse events.
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