Date of Award

2013

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this systematic review is to determine whether or not local infiltration analgesia (LIA) is a safe and effective method for post-operative pain management after a unilateral total knee arthroplasty (TKA).
STUDY DESIGN: Review of three English language primary studies published in 2010 and 2011.

DATA SOURCES: Three randomized controlled trials comparing local infiltration analgesia to three separate controls: epidural analgesia, placebo infiltration and femoral nerve block found using PubMed.

OUTCOMES MEASURED: Clinical outcome was measured by total morphine use postoperatively and average knee pain intensity at rest and upon movement postoperatively. Total morphine use in milligrams used postoperatively was determined by amount used via IV PCA pump; each study differed upon postoperative follow-up periods. Average knee pain intensity at rest and upon movement was measured by subjective average VAS/NRS scores (0-100 mm visual analog scale; 0 = no pain, 100 = worst pain imaginable). Studies varied among postoperative time periods when VAS score was recorded from each patient. Data was analyzed with Mann-Whitney U-test.

RESULTS: In the study by Affas et al, LIA was found to have similar analgesic effects measured by average pain intensity and average total morphine use during first post-operative 24 hours, as the control femoral nerve block technique, but not to the point of statistical significance. In the study by Essving et al, the LIA group had a median morphine consumption during the first 48 hours postoperatively statistically significantly less than the placebo group. LIA also proved to have statistically significantly lower median VAS pain scores than the placebo group postoperatively. In the study by Andersen et al, morphine consumption and average VAS scores at rest and during mobilization were statistically significantly lower in group A (LIA) versus the control group (epidural analgesia).

CONCLUSIONS: The results of two of the RCTs show local infiltration analgesia to be an effective method for post-operative pain management after a unilateral TKA (Essving and Andersen).6,7 One RCT does not reach statistical significance (Affas).5 Safety of LIA was demonstrated with minimal ADR’s in all RCTs.5,6,7

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