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Dong P, Tang X, Cheng R, et al. Comparison of the Efficacy of Different Analgesia Treatments for Total Knee Arthroplasty: A Network Meta-Analysis. Clin J Pain. 2018 Nov;34(11):1047-1060. doi: 10.1097/AJP.0000000000000631. (Systematic review)
Abstract

BACKGROUND AND AIM: The 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.

METHODS: Embase 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.

RESULTS: A 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).

CONCLUSIONS: Considering both pain score and morphine consumption, cFNB was potentially the most efficacious postoperative treatment for patients undergoing TKA.

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Comments from MORE raters

Physician rater

Studies on post-op pain control after TKA continue to be published, so it is difficult to say this comparison will hold up after another year or two of many more publications. With that said, it is a good attempt at comparing the myriad of therapies available now.

Physician rater

It would be interesting to see whether the use of single or continuous femoral nerve block has any significant impact on the starting of mobilization and on the length of hospitalization.
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