A Network Meta-Analysis of Randomized Controlled Trials Assessing Intraoperative Anesthetic Therapies for Analgesic Efficacy and Morphine Consumption Following Total Knee Arthroplasty

Jae Doo Yoo, Min Hwan Huh, Seung Hyun Lee, Darryl D. D'Lima, Young Soo Shin

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The purpose of this study was to compare intraoperative anesthetic therapies for total knee arthroplasty (TKA) regarding postoperative analgesic efficacy and morphine consumption by conducting a systematic literature search. Methods: Randomized controlled trials of TKA using various anesthetic therapies were identified from various databases from conception through December 31, 2021. A network meta-analysis of relevant literature was performed to investigate which treatment showed better outcomes. In total, 40 trials were included in this study. Results: Surface under the cumulative ranking curve showed local infiltration anesthesia (LIA) with saphenous nerve block (SNB) to produce the best pain relief on postoperative days (PODs) 1 and 2 and the best reduction of morphine consumption on PODs 1 and 3. However, femoral nerve block showed the largest effect on pain relief on POD 3, and liposomal bupivacaine showed the largest effect on reduction of morphine consumption on POD 2. Conclusions: According to this network meta-analysis, surface under the cumulative ranking curve percentage showed that LIA with SNB provided the best analgesic effect after TKA. Furthermore, patients receiving LIA with SNB had the lowest consumption of morphine. Although femoral nerve block resulted in better pain relief on POD 3, LIA with SNB could be selected first when trying to reduce morphine consumption or increase early ambulation.

Original languageEnglish
Pages (from-to)1361-1373
Number of pages13
JournalJournal of Arthroplasty
Volume39
Issue number5
DOIs
StatePublished - May 2024

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

  • TKA
  • femoral nerve block
  • liposomal bupivacaine
  • local infiltration anesthesia
  • morphine consumption
  • saphenous nerve block

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