Continuous Local Infiltration Analgesia after TKA: A Meta-Analysis
Renee Keijsers1, Michel van den Bekerom2, Rogier van Delft3
1Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
The Journal of Knee Surgery
|July 21, 2015
Summary
Continuous local infiltration analgesia (CLIA) offers improved pain relief for total knee arthroplasty (TKA) patients compared to placebo, particularly in the first 24 hours. While effects diminish by day three, CLIA shows promise for extended pain management post-TKA.
Area of Science:
- Orthopedics
- Anesthesiology
- Pain Management
Background:
- Local infiltration analgesia (LIA) provides short-term pain relief after total knee arthroplasty (TKA), typically less than 24 hours.
- Continuous LIA (CLIA) has emerged as a strategy to prolong analgesia through continuous infusion or repeated boluses.
Purpose of the Study:
- To evaluate the efficacy of CLIA compared to single-shot LIA (SLIA) and placebo for pain management following TKA.
- To assess pain reduction using visual analogue scale (VAS) scores at various time points (24, 48, 72 hours) post-surgery.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing intra-articular CLIA with SLIA or placebo for TKA.
- Inclusion of 11 RCTs, with meta-analyses performed on comparable studies using fixed or random effects models.
- Primary outcome measures included VAS scores at rest and during activity at 24, 48, and 72 hours post-TKA.
Main Results:
- CLIA demonstrated a significant 46% reduction in VAS scores at rest 24 hours post-TKA compared to placebo.
- Pain reduction was significant for CLIA during activity at 24 and 48 hours post-TKA compared to placebo.
- CLIA showed improved VAS scores at rest 48 hours post-TKA compared to SLIA, though heterogeneity limited firm conclusions.
Conclusions:
- CLIA may offer a reduced pain perception for up to 24 hours post-TKA at rest.
- The analgesic benefit of CLIA might extend to 48 hours post-TKA during activity.
- High heterogeneity across studies necessitates caution in drawing definitive conclusions regarding CLIA's long-term efficacy.
