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Table 1 Randomised controlled trials of local anaesthetic wound infiltration in hip or knee joint replacement

From: The effect of local anaesthetic wound infiltration on chronic pain after lower limb joint replacement: A protocol for a double-blind randomised controlled trial

Author Study design
Patients
Longest follow up
Common treatment Results
   Intervention Control  
Bianconi
2003[20]
Italy
RCT
TJR
N = 37
72 hours
Spinal anaesthsia with bipuvicaine and a loading dose of intravenous morphine 10 mg. Intravenous infusion of normal saline at the same rate for 24 hours VAS pain at rest and on mobilisation significantly reduced in the intervention group up to 72 hours. Use of diclofenac and tramadol lower in the intervention group, and length of hospital stay reduced. Patient satisfaction greater in the intervention group.
   Wound infiltration with ropivacaine solution followed by wound perfusion for 55 hours Baseline intra-venous infusion of morphine plus ketorolac for 24 hours  
Toftdahl
2007 [21]
Sweden
RCT
TKR
N = 80
24 hours
Spinal anaesthesia and controlled release oxycodon Intervention group had a quicker recovery, lower pain scores, and lower use of opioids. There was no difference in side effects or length of hospital stay.
   Peri- and intraarticular infiltration and injection Continuous femoral nerve block  
Andersen
2007 [22]
Denmark
RCT
THR
N = 80
Until discharge
Spinal anaesthesia   Pain reduced in intervention group. Narcotic consumption was reduced and the length of hospital stay was shorter.
   Wound infiltration and intraarticular injection of local anaesthetic Epidural infusion  
Andersen
2007 [23]
Denmark
RCT
THR
N = 40
6 weeks
Spinal anaesthesia Patients who received the active wound infiltration had less pain for up to 2 weeks. They reached an earlier and lower pain minimum during the first days post-operatively, had lower use of analgesia up to day 4 post-operatively, and were more satisfied. Use of analgesic solution resulted in less joint stiffness and better function 1 week postoperatively. No significant benefit at 6 weeks.
   Wound infiltration with ropivacaine, ketorolac, and adrenaline at the end of surgery and through an intraarticular catheter 24 hours post-operatively Saline infiltration  
Vendittoli
2006 [33]
Canada
RCT
TKR
N = 42
24 hours
Spinal anaesthesia and patient controlled morphine Morphine use and the incidence of nausea was significantly lower in the intervention group.
   Perioperative infiltration of local anesthetic   
Busch
2006 [25]
Canada
RCT
TKR
N = 64
6 weeks
Spinal anaesthesia and patient controlled morphine Patient-controlled analgesia use was reduced in the 24 hours after surgery in the intervention group. VAS pain scores also improved in the intervention group after the operation. No significant benefit at 6 weeks.
   Locally injected anaesthetic   
Andersen
2008 [29]
Denmark
Individual patient
knees randomised to
intervention or
control.
TKR (bilateral)
N = 12
48 hours
Spinal anaesthesia and patient controlled morphine Pain at rest and during movement significantly reduced for up to 32 hrs in the intervention group.
   Infiltration with ropivacaine and epinephrine. Further intra-articular injections through catheter over 24 hours. Similar procedures with saline.  
Essving
2009 [32]
Sweden
RCT
Unicompartmental
knee arthroplasty
N = 40
6 months
General anaesthesia and patient controlled Essving morphine Hospital stay shorter in intervention group. Post-operative pain lower at rest during 27 hr in-hospital follow up. Morphine consumption lower for the first 48 hr in intervention group. Also lower frequency of nausea, pruritus, and sedation. No benefit in Oxford knee score and EQ-5 D in intervention group at 3 or 6 months.
   Periarticular infiltration of ropivacaine, ketorolac and epinephrine. Further injection through catheter at 21 hrs. Similar volume of saline injected via catheter  
Fu
2009 [19]
China
RCT
TKR
N = 80
15 days (pain)
Spinal anaesthesia and patient controlled morphine Significant reduction in morphine consumption. VAS pain at rest and activity improved up to 36 hours. No difference in VAS pain from 48 hours.
   Intraoperative intra-articular injection and infiltration of morphine, bupivacaine and betamethasone Similar procedure with saline  
Parvataneni
2007 [30]
USA
RCT
TKR
N = 60
3 months
Spinal anaesthesia with or without femoral nerve block Non-significant reduction in VAS pain and greater satisfaction in intervention group on day 1 but later VAS pain and satisfaction were similar. Narcotic consumption was reduced in the intervention group. The intervention was associated with quicker functional recovery but length of hospital stay was similar between the groups.
   Local periarticular injection of bupivacaine, morphine sulfate, epinephrine, methylprednisolone acetate, cefuroxime Patient controlled analgesia (ketoralac and, if ineffective, morphine)  
Parvataneni
2007 [30]
USA
RCT
THR
N = 71
3 months
Spinal anaesthesia with or without femoral nerve block VAS pain reduced in intervention group at 3 days but similar at 6 weeks and 3 months. Satisfaction greater in hospital in intervention group but similar at 6 weeks and 3 months. Lower narcotic use in intervention group. Functional recovery was quicker and the hospital stay shorter in the intervention group.
   Local periarticular injection of bupivacaine, morphine sulfate, epinephrine, methylprednisolone acetate, cefuroxime Patient controlled analgesia (ketoralac and, if ineffective, morphine)  
Zhang
2007[31]
China
RCT
TKR
N = 60
72 hours
Patient controlled analgesia VAS pain at rest and on activity reduced in intervention group until 24 hours. No difference at 36-72 hours. Reduced post-operative tramadol use in intervention group. Range of motion improved in intervention group at 72 hours.
   Intraoperative periarticular injection of bupivacaine, epinephrine and morphine No drug infiltration  
Gomez- Cardero
2010 [26]
Spain
RCT
TKR
N = 50
1 month
Spinal anaesthesia Cardero Pain intensity and opiod use in the first 3 days post-operative were reduced in the intervention group. Length of hospital stay was lower in the intervention group. There was no difference in pain intensity at 1- month post-operative.
   Continous intraarticular infusion with ropivacaine Saline infusion  
Essving
2010 [27]
Sweden
RCT
TKR
N = 48
3 months
General anaesthesia and patient controlled morphine Morphine consumption and pain intensity on movement was reduced in the intervention group in the first 48 hours post-operative. Patient satisfaction was higher in the intervention group. Length of stay was not affected and no significant benefit was evident at 3-months post-operative.
   Intraarticular injection of ropivacaine, ketorolac and epinephrine during surgery and through a catheter at 21 hours post-operatively No injection during surgery and saline injection at 21 hours post-operatively  
Chen
2010[28]
Taiwan
RCT
THR
N = 92
Discharge
General anaesthesia Intervention group had a longer mean time to first narcotic rescue, but there was no difference in pain relief, narcotic use or length of stay.
   Continous intra-articular infusion of bupivacaine via a infusion pump for 48 hours Continous intra-articular infusion of saline via a infusion pump for 48 hours  
  1. RCT = randomised controlled trial, TKR = total knee replacement, THR = total hip replacement, TJR = total joint replacement