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Functional recovery after knee arthroplasty with regional analgesia

A systematic review and meta-analysis of randomised controlled trials

Osinski, Thomas; Bekka, Samir; Regnaux, Jean-Philippe; Fletcher, Dominique; Martinez, Valeria

European Journal of Anaesthesiology (EJA): June 2019 - Volume 36 - Issue 6 - p 418–426
doi: 10.1097/EJA.0000000000000983
Loco-regional anaesthesia
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BACKGROUND Regional analgesia (RA) has been widely evaluated for pain relief after total knee arthroplasty (TKA). Its impact on functional recovery is less well known.

OBJECTIVES To evaluate the functional benefits of RA after TKA.

DESIGN Systematic review with a random-effects meta-analysis of randomised controlled trials comparing LRA with systemic analgesia on function in adults undergoing TKA for osteoarthritis.

DATABASE SOURCES MEDLINE, EMBASE, LILAC, Cochrane, CTRD databases.

OUTCOMES Length of stay (LOS) in hospital and early knee flexion range of motion (ROM), early and long-term knee function, serious adverse effects.

RESULTS Twenty-three studies (1246 patients) were included. LOS was significantly shorter for RA than for systemic analgesia (0.90 days, 95% confidence interval 0.3 to 1.4). Subgroup analyses found that only infiltration analgesia decreased the LOS. ROM during the first week was significantly higher for all techniques of RA than for systemic analgesia (9.23°, 95% confidence interval 4.6 to 13.9). No impact of regional analgesia techniques on global function in the longer term was demonstrated. No difference in serious adverse effects was found between RA and systemic analgesia.

CONCLUSION RA techniques compared with systemic analgesia have a beneficial impact on the LOS and the ROM achieved in the early postoperative period. Global function in the longer term after surgery seems unaffected by peri-operative RA.

TRIAL REGISTRATION CRD42014013995.

From the Service d’anesthésie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris (SB, DF, VM), INSERM, U-987, Hôpital Ambroise Paré, Centre d’Evaluation et de Traitement de la Douleur (TO, DF, VM), Université Versailles Saint-Quentin, Paris (DF, VM) and Département sciences infirmières et paramédicales Ecole des Hautes Etudes en santé publique, Rennes, France (J-PR)

Correspondence to Valeria Martinez, MD, PhD, Service d’anesthésie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris, Paris, France E-mail: valeria.martinez@aphp.fr

Published online 3 April 2019

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© 2019 European Society of Anaesthesiology