Junheng Chen1, Chunbin Zhou2, Chuzhou Ma1, Guoliang Sun3, Lianxiong Yuan4, Ziqing Hei3, Chunming Guo5, Weifeng Yao6. 1. Department of Anesthesiology, Shantou Central Hospital, Shantou, China. 2. Department of Orthopedic, First Affiliated Hospital of Shantou University, Guangdong Province, People's Republic of China. 3. Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, People's Republic of China. 4. Department of Research Service Office, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, People's Republic of China. 5. Department of Anesthesiology, Shantou Central Hospital, Shantou, China. Electronic address: stzxyygcm@163.com. 6. Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, People's Republic of China. Electronic address: yaowf3@mail.sysu.edu.cn.
Abstract
STUDY OBJECTIVE: To review all randomized controlled trials (RCTs) comparing the analgesic efficacy of adductor canal block (ACB), periarticular infiltration (PAI), and any other mode of these treatments in analgesia, such as PAI with liposomal bupivacaine (LB), continuous adductor canal block (cACB) or ACB + PAI, after total knee arthroplasty (TKA). DESIGN: Systematic review and network meta-analysis of RCTs. PATIENTS: We searched PubMed, Embase, and the Cochrane database to detect all relevant RCTs on investigating the analgesic effects of ACB, PAI and LB for TKA published until April 2020. INTERVENTIONS: Use of different analgesic methods of ACB, PAI, cACB, ACB + PAI and LB. MEASUREMENTS: The primary endpoint was visual analog scale (VAS) score at rest and movement. The secondary endpoints were opioids consumption, length of hospitalization and knee range of motion (ROM). We used Cochrane risk of bias to assess the quality of evidence for outcomes. RESULTS: Forty-two studies involving 3785 patients with 5 different methods containing ACB, PAI, ACB + PAI, continuous ACB (cACB), LB, were evaluated. According to surface under the cumulative ranking curve value, 24 h resting VAS score was the lowest the ACB + PAI (88.4%), followed by cACB (73.4%); Resting VAS score at 48 h and movement VAS score at 24 h and 48 h was the lowest in the cACB (99.9%, 92% and 100%). Total opioids consumption was the least in LB (81.4%) before cACB (60.8%). ROM was the largest in the ACB + PAI (84.1%) before cACB (78.8%). CONCLUSION: Although all analgesic methods available were not evaluated, and further studies are needed to establish our results, the 24 h resting VAS score was lowest in ACB + PAI and 48 h resting and movement VAS score was lowest in cACB. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD 42020168102).
STUDY OBJECTIVE: To review all randomized controlled trials (RCTs) comparing the analgesic efficacy of adductor canal block (ACB), periarticular infiltration (PAI), and any other mode of these treatments in analgesia, such as PAI with liposomal bupivacaine (LB), continuous adductor canal block (cACB) or ACB + PAI, after total knee arthroplasty (TKA). DESIGN: Systematic review and network meta-analysis of RCTs. PATIENTS: We searched PubMed, Embase, and the Cochrane database to detect all relevant RCTs on investigating the analgesic effects of ACB, PAI and LB for TKA published until April 2020. INTERVENTIONS: Use of different analgesic methods of ACB, PAI, cACB, ACB + PAI and LB. MEASUREMENTS: The primary endpoint was visual analog scale (VAS) score at rest and movement. The secondary endpoints were opioids consumption, length of hospitalization and knee range of motion (ROM). We used Cochrane risk of bias to assess the quality of evidence for outcomes. RESULTS: Forty-two studies involving 3785 patients with 5 different methods containing ACB, PAI, ACB + PAI, continuous ACB (cACB), LB, were evaluated. According to surface under the cumulative ranking curve value, 24 h resting VAS score was the lowest the ACB + PAI (88.4%), followed by cACB (73.4%); Resting VAS score at 48 h and movement VAS score at 24 h and 48 h was the lowest in the cACB (99.9%, 92% and 100%). Total opioids consumption was the least in LB (81.4%) before cACB (60.8%). ROM was the largest in the ACB + PAI (84.1%) before cACB (78.8%). CONCLUSION: Although all analgesic methods available were not evaluated, and further studies are needed to establish our results, the 24 h resting VAS score was lowest in ACB + PAI and 48 h resting and movement VAS score was lowest in cACB. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD 42020168102).
Authors: Fabio A Rodriguez-Patarroyo; Nadin Cuello; Robert Molloy; Viktor Krebs; Alparslan Turan; Nicholas S Piuzzi Journal: EFORT Open Rev Date: 2021-12-10
Authors: Sara J Hyland; Kara K Brockhaus; William R Vincent; Nicole Z Spence; Michelle M Lucki; Michael J Howkins; Robert K Cleary Journal: Healthcare (Basel) Date: 2021-03-16