Local Infiltration Analgesia for Postoperative Pain after Hip Arthroplasty: A Meta-analysis_West China Medical Journal

Authors：

 ZhangHuiwei ¹ ,  LiuKai ² , PangBo ¹ , LuWenjiang ¹ , WangHongchuan ² , JiangJunwei ²

1. Department of Anesthesiology, People's Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;
2. Department of Orthopedics, People's Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

LiuKai, Email: 285061643@qq.com

Keywords：

Local infiltration analgesia; Hip arthroplasty; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1002-0179.201600333

Video：

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Objective To evaluate the impact of local infiltration analgesia on postoperative pain after hip arthroplasty. Methods Relevant randomized controlled trials comparing the analgesia effect and adverse effects between local infiltration analgesia group and non-local infiltration analgesia group (control group) were identified from Cochrane Library, Embase, PubMed, China National Knowledge Infrastructure, VIP database and Wanfang database from their establishment until May 2016. A systematic review was performed to compare the pain scores and adverse events between those two groups. Effective data were pooled for Meta-analysis with software RevMan 5.2.0. Results Twelve eligible trials were identified in this study. The pain scores of the two groups of patients during rest time after surgery were significantly different[WMD=-19.06, 95%CI (-21.51, -16.62), P<0.000 01]; the pain scores were also significantly different during activity time[WMD=-11.45, 95%CI (-15.56, -7.34), P<0.000 01]. There was significant difference in postoperative nausea and vomiting between the two groups[RR=0.59, 95%CI (0.42, 0.84), P=0.003]. The pain degree and incidence of nausea and vomiting in the local infiltration analgesia group were lower than the control group, but there was no significant difference between the two groups in terms of urinary retention, itch and hypotension (P>0.05). Conclusion Local infiltration analgesia is effective in reducing postoperative pain without any additional adverse reactions.

Citation： ZhangHuiwei, LiuKai, PangBo, LuWenjiang, WangHongchuan, JiangJunwei. Local Infiltration Analgesia for Postoperative Pain after Hip Arthroplasty: A Meta-analysis. West China Medical Journal, 2016, 31(7): 1220-1226. doi: 10.7507/1002-0179.201600333 Copy

1.	杨益琼, 巫万玺, 张丽萍, 等. 住院患者疼痛管理现状及满意度调查分析[J]. 华西医学, 2013, 28(12):1909-1913.
2.	Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty[J]. Anesth Analg, 2010, 111(6):1552-1554.
3.	孙立, 田晓滨, 陈涛, 等. 局部浸润镇痛在老年全髋关节置换术后多模式镇痛中的作用及安全性[J]. 中华关节外科杂志:电子版, 2014, 8(2):151-155.
4.	刘伟, 吴宇黎, 吴海山, 等. 关节内注射镇痛混合剂在全髋关节置换术后的应用[J]. 实用骨科杂志, 2011, 17(12):1077-1080, 1113.
5.	Murphy TP, Byrne DP, Curtin P, et al. Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty?[J]. Clin Orthop Relat Res, 2012, 470(4):1151-1157.
6.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials, 1996, 17(1):1-12.
7.	Andersen KV, Pfeiffer-Jensen M, Haraldsted V, et al. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty:a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients[J]. Acta Orthop, 2007, 78(2):180-186.
8.	Andersen LJ, Poulsen T, Krogh B, et al. Postoperative analgesia in total hip arthroplasty:a randomized double-blinded, placebo-controlled study on peroperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration[J]. Acta Orthop, 2007, 78(2):187-192.
9.	Chen DW, Hsieh PH, Huang KC, et al. Continuous intra-articular infusion of bupivacaine for post-operative pain relief after total hip arthroplasty:a randomized, placebo-controlled, double-blind study[J]. Eur J Pain, 2010, 14(5):529-534.
10.	Aguirre J, Baulig B, Dora C, et al. Continuous epicapsular ropivacaine 0.3% infusion after minimally invasive hip arthroplasty:a prospective, randomized, double-blinded, placebo-controlled study comparing continuous wound infusion with morphine patient-controlled analgesia[J]. Anesth Analg, 2012, 114(2):456-461.
11.	Solovyova O, Lewis CG, Abrams JH, et al. Local infiltration analgesia followed by continuous infusion of local anesthetic solution for total hip arthroplasty:a prospective, randomized, double-blind, placebo-controlled study[J]. J Bone Joint Surg Am, 2013, 95(21):1935-1941.
12.	翁文杰, 王锋, 陈东阳, 等. 全髋关节置换术中局部注射混合镇痛液疗效的临床对照试验[J]. 中国骨伤, 2008, 21(11):834-836.
13.	Busch CA, Whitehouse MR, Shore BJ, et al. The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty[J]. Clin Orthop Relat Res, 2010, 468(8):2152-2159.
14.	Lunn TH, Husted H, Solgaard S, et al. Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty:a randomized, double-blind, placebo-controlled trial[J]. Reg Anesth Pain Med, 2011, 36(5):424-429.
15.	Dobie I, Bennett D, Spence DJ, et al. Periarticular local anesthesia does not improve pain or mobility after THA[J]. Clin Orthop Relat Res, 2012, 470(7):1958-1965.
16.	Andersen LØ, Otte KS, Husted H, et al. High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial[J]. Acta Orthop, 2011, 82(4):423-426.
17.	李勇, 蔡林, 龚泰芳, 等. 关节周围局部注射镇痛药对全膝关节置换后镇痛的Meta分析[J]. 中国组织工程研究与临床康复, 2011, 15(52):9823-9828.
18.	Singelyn FJ, Ferrant T, Malisse MF, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty[J]. Reg Anesth Pain Med, 2005, 30(5):452-457.
19.	Marques EM, Jones HE, Elvers KT, et al. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement:systematic review and meta-analyses of short- and long-term effectiveness[J]. BMC Musculoskelet Disord, 2014, 15(1):220.

1. 杨益琼, 巫万玺, 张丽萍, 等. 住院患者疼痛管理现状及满意度调查分析[J]. 华西医学, 2013, 28(12):1909-1913.
2. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty[J]. Anesth Analg, 2010, 111(6):1552-1554.
3. 孙立, 田晓滨, 陈涛, 等. 局部浸润镇痛在老年全髋关节置换术后多模式镇痛中的作用及安全性[J]. 中华关节外科杂志:电子版, 2014, 8(2):151-155.
4. 刘伟, 吴宇黎, 吴海山, 等. 关节内注射镇痛混合剂在全髋关节置换术后的应用[J]. 实用骨科杂志, 2011, 17(12):1077-1080, 1113.
5. Murphy TP, Byrne DP, Curtin P, et al. Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty?[J]. Clin Orthop Relat Res, 2012, 470(4):1151-1157.
6. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials, 1996, 17(1):1-12.
7. Andersen KV, Pfeiffer-Jensen M, Haraldsted V, et al. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty:a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients[J]. Acta Orthop, 2007, 78(2):180-186.
8. Andersen LJ, Poulsen T, Krogh B, et al. Postoperative analgesia in total hip arthroplasty:a randomized double-blinded, placebo-controlled study on peroperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration[J]. Acta Orthop, 2007, 78(2):187-192.
9. Chen DW, Hsieh PH, Huang KC, et al. Continuous intra-articular infusion of bupivacaine for post-operative pain relief after total hip arthroplasty:a randomized, placebo-controlled, double-blind study[J]. Eur J Pain, 2010, 14(5):529-534.
10. Aguirre J, Baulig B, Dora C, et al. Continuous epicapsular ropivacaine 0.3% infusion after minimally invasive hip arthroplasty:a prospective, randomized, double-blinded, placebo-controlled study comparing continuous wound infusion with morphine patient-controlled analgesia[J]. Anesth Analg, 2012, 114(2):456-461.
11. Solovyova O, Lewis CG, Abrams JH, et al. Local infiltration analgesia followed by continuous infusion of local anesthetic solution for total hip arthroplasty:a prospective, randomized, double-blind, placebo-controlled study[J]. J Bone Joint Surg Am, 2013, 95(21):1935-1941.
12. 翁文杰, 王锋, 陈东阳, 等. 全髋关节置换术中局部注射混合镇痛液疗效的临床对照试验[J]. 中国骨伤, 2008, 21(11):834-836.
13. Busch CA, Whitehouse MR, Shore BJ, et al. The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty[J]. Clin Orthop Relat Res, 2010, 468(8):2152-2159.
14. Lunn TH, Husted H, Solgaard S, et al. Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty:a randomized, double-blind, placebo-controlled trial[J]. Reg Anesth Pain Med, 2011, 36(5):424-429.
15. Dobie I, Bennett D, Spence DJ, et al. Periarticular local anesthesia does not improve pain or mobility after THA[J]. Clin Orthop Relat Res, 2012, 470(7):1958-1965.
16. Andersen LØ, Otte KS, Husted H, et al. High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial[J]. Acta Orthop, 2011, 82(4):423-426.
17. 李勇, 蔡林, 龚泰芳, 等. 关节周围局部注射镇痛药对全膝关节置换后镇痛的Meta分析[J]. 中国组织工程研究与临床康复, 2011, 15(52):9823-9828.
18. Singelyn FJ, Ferrant T, Malisse MF, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty[J]. Reg Anesth Pain Med, 2005, 30(5):452-457.
19. Marques EM, Jones HE, Elvers KT, et al. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement:systematic review and meta-analyses of short- and long-term effectiveness[J]. BMC Musculoskelet Disord, 2014, 15(1):220.

West China Medical Journal

Local Infiltration Analgesia for Postoperative Pain after Hip Arthroplasty: A Meta-analysis

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