PMID- 26559294
OWN - NLM
STAT- MEDLINE
DCOM- 20160225
LR  - 20221005
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 94
IP  - 45
DP  - 2015 Nov
TI  - Continuous Local Infiltration Analgesia for Pain Control After Total Knee 
      Arthroplasty: A Meta-analysis of Randomized Controlled Trials.
PG  - e2005
LID - 10.1097/MD.0000000000002005 [doi]
LID - e2005
AB  - A total knee arthroplasty (TKA) has always been associated with moderate to 
      severe pain. As more research is conducted on the use of continuous local 
      infiltration analgesia (CLIA) to manage pain after a TKA, it is necessary to 
      reassess the efficacy and safety of the TKA method. The purpose of this 
      systematic review and meta-analysis of randomized controlled trials was to 
      evaluate the efficacy and safety of pain control of CLIA versus placebo after a 
      TKA. In January 2015, a systematic computer-based search was conducted in the 
      Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of 
      Science, Google database, and Chinese Wanfang databases. This systematic review 
      and meta-analysis were performed according to the Preferred Reporting Items for 
      Systematic Reviews and Meta-analyses statement criteria. The primary endpoint was 
      the visual analog scale score after a TKA with rest or mobilization at 24, 48, 
      and 72 hours, which represents the effect of pain control after TKA. The 
      complications of infection, nausea, and whether it prolonged wound drainage were 
      also compiled to assess the safety of CLIA. RevMan 5.30 software was used for the 
      meta-analysis. After testing for publication bias and heterogeneity across 
      studies, data were aggregated for random-effects modeling when necessary. Ten 
      studies involving 735 patients met the inclusion criteria. The meta-analysis 
      revealed that continuous infusion analgesia provided better pain control with 
      rest at 24 hours (mean difference [MD] -12.54, 95% confidence interval [CI] 
      -16.63 to 8.45), and with mobilization at 24 hours (MD -18.27, 95% CI -27.52 to 
      9.02) and 48 hours (MD -14.19, 95% CI -21.46 to 6.93). There was no significant 
      difference with respect to the visual analog scale score at 48 hours (MD -6.15, 
      95% CI -13.51 to 1.22, P = 0.10) and 72 hours (MD -3.63, 95% CI -10.43 to 3.16, 
      P = 0.29) with rest and at 72 hours with mobilization (MD -4.25, 95% CI -16.27 to 
      7.77, P = 0.49). However, CLIA increased the rate of infection (relative risk 
      [RR] 3.16, 95% CI 1.18-8.50, P = 0.02) and the rate of nausea or vomiting (RR 
      0.60, 95% CI 0.37-0.96, P = 0.03). There were no significant differences in the 
      length of hospital stay (MD -0.34, 95% CI -1.09 to 0.42, P = 0.38), deep venous 
      thrombosis (RR 1.02, 95% CI 0.30 to 1.41, P = 0.99), or duration of surgery (MD 
      1.20, 95% CI -4.59 to 6.98, P = 0.69). On the basis of the current meta-analysis, 
      CLIA was more efficacious for reducing postoperative pain than the placebo at 
      24 hours with rest and at 24 and 48 hours with mobilization, but it increased the 
      risk of infection. However, CLIA did not prolong the length of hospital stay or 
      the duration of surgery. There was also a higher heterogeneity of different 
      analgesic drugs mixed and a high risk of selection bias in this analysis; 
      therefore, more high-quality randomized controlled trials with standardized CLIA 
      are necessary for proper comparisons of this technique with other methods.
FAU - Sun, Xiao-Lei
AU  - Sun XL
AD  - From the Department of Orthopaedics, Tianjin Hospital (X-LS, Z-HZ, J-XM, F-BL, 
      Y-JL, X-MM, X-LM); and Graduate School of Tianjin Medical University, Tianjin, 
      China (Z-HZ).
FAU - Zhao, Zhi-Hu
AU  - Zhao ZH
FAU - Ma, Jian-Xiong
AU  - Ma JX
FAU - Li, Feng-Bo
AU  - Li FB
FAU - Li, Yan-Jun
AU  - Li YJ
FAU - Meng, Xin-Min
AU  - Meng XM
FAU - Ma, Xin-Long
AU  - Ma XL
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Analgesics)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analgesics/administration & dosage/adverse effects/*therapeutic use
MH  - Arthroplasty, Replacement, Knee/*methods
MH  - Catheters
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Nausea/chemically induced
MH  - Pain Measurement
MH  - Pain, Postoperative/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Surgical Wound Infection/epidemiology
PMC - PMC4912288
COIS- The authors have conflicts of interest to disclose.
EDAT- 2015/11/13 06:00
MHDA- 2016/02/26 06:00
PMCR- 2015/11/13
CRDT- 2015/11/13 06:00
PHST- 2015/11/13 06:00 [entrez]
PHST- 2015/11/13 06:00 [pubmed]
PHST- 2016/02/26 06:00 [medline]
PHST- 2015/11/13 00:00 [pmc-release]
AID - 00005792-201511110-00049 [pii]
AID - 10.1097/MD.0000000000002005 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2015 Nov;94(45):e2005. doi: 10.1097/MD.0000000000002005.