Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

Details

Serval ID
serval:BIB_C6C27BC1B158
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.
Journal
Anaesthesia
Author(s)
Kirkham K.R., Grape S., Martin R., Albrecht E.
ISSN
1365-2044 (Electronic)
ISSN-L
0003-2409
Publication state
Published
Issued date
12/2017
Peer-reviewed
Oui
Volume
72
Number
12
Pages
1542-1553
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Review
Publication Status: ppublish
Abstract
Many published reports consider blockade of the femoral nerve distribution the best available analgesic treatment after anterior cruciate ligament reconstruction. However, some argue that an alternative approach of infiltrating local anaesthetic into the surgical site has similar efficacy. The objectives of this meta-analysis were to compare the analgesic and functional outcomes of both treatments following anterior ligament reconstruction. The primary outcomes were pain scores at rest (analogue scale, 0-10) in the early (0-2 postoperative hours), intermediate (3-12 hours) and late postoperative periods (13-24 hours). Secondary outcomes included range of motion, quadriceps muscle strength and complication rates (neurological problems, cardiovascular events, falls and knee infections). Eleven trials, including 628 patients, were identified. Pain scores in the early, intermediate and late postoperative periods were significantly lower in patients who received a femoral nerve block, with mean differences (95%CI) of 1.6 (0.2-2.9), p = 0.02; 1.2 (0.4-1.5), p = 0.002; and 0.7 (0.1-1.4), p = 0.03 respectively. The quality of evidence for our primary outcomes was moderate to high. Regarding functional outcomes, only one trial reported a similar range of motion between groups at 48 postoperative hours. No trial sought to record complications. In conclusion, femoral nerve block provides superior postoperative analgesia after anterior cruciate ligament reconstruction to local infiltration analgesia. The impact of improved analgesia on function remains unclear due to the lack of reporting of functional outcomes in the existing literature.
Keywords
Analgesia/methods, Analgesics/therapeutic use, Anterior Cruciate Ligament Reconstruction, Femoral Nerve/drug effects, Nerve Block/methods, Pain Management/methods, Pain, Postoperative/drug therapy, Treatment Outcome, analgesia, anterior cruciate ligament reconstruction, local infiltration analgesia, peripheral nerve block, postoperative pain, regional anaesthesia
Pubmed
Web of science
Open Access
Yes
Create date
05/10/2017 10:44
Last modification date
20/08/2019 16:42
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