Table 1 Randomised controlled trials of local anaesthetic wound infiltration in hip or knee joint replacement
Author | Study design Patients Longest follow up | Common treatment | Results | |
|---|---|---|---|---|
| Â | Â | Intervention | Control | Â |
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. | |
| Â | Â | Wound infiltration with ropivacaine solution followed by wound perfusion for 55 hours | Baseline intra-venous infusion of morphine plus ketorolac for 24 hours | Â |
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. | |
| Â | Â | Peri- and intraarticular infiltration and injection | Continuous femoral nerve block | Â |
Andersen 2007 [22] Denmark | RCT THR N = 80 Until discharge | Spinal anaesthesia | Â | Pain reduced in intervention group. Narcotic consumption was reduced and the length of hospital stay was shorter. |
| Â | Â | Wound infiltration and intraarticular injection of local anaesthetic | Epidural infusion | Â |
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. | |
| Â | Â | Wound infiltration with ropivacaine, ketorolac, and adrenaline at the end of surgery and through an intraarticular catheter 24 hours post-operatively | Saline infiltration | Â |
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. | |
| Â | Â | Perioperative infiltration of local anesthetic | Â | Â |
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. | |
| Â | Â | Locally injected anaesthetic | Â | Â |
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. | |
| Â | Â | Infiltration with ropivacaine and epinephrine. Further intra-articular injections through catheter over 24 hours. | Similar procedures with saline. | Â |
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. | |
| Â | Â | Periarticular infiltration of ropivacaine, ketorolac and epinephrine. Further injection through catheter at 21 hrs. | Similar volume of saline injected via catheter | Â |
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. | |
| Â | Â | Intraoperative intra-articular injection and infiltration of morphine, bupivacaine and betamethasone | Similar procedure with saline | Â |
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. | |
| Â | Â | Local periarticular injection of bupivacaine, morphine sulfate, epinephrine, methylprednisolone acetate, cefuroxime | Patient controlled analgesia (ketoralac and, if ineffective, morphine) | Â |
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. | |
| Â | Â | Local periarticular injection of bupivacaine, morphine sulfate, epinephrine, methylprednisolone acetate, cefuroxime | Patient controlled analgesia (ketoralac and, if ineffective, morphine) | Â |
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. | |
| Â | Â | Intraoperative periarticular injection of bupivacaine, epinephrine and morphine | No drug infiltration | Â |
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. | |
| Â | Â | Continous intraarticular infusion with ropivacaine | Saline infusion | Â |
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. | |
| Â | Â | 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 | Â |
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. | |
| Â | Â | 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 | Â |