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Table 3 Meta-analyses of pain and length of hospital stay by anaesthetic regimen compared with controls using a random effects model

From: Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness

TOTAL HIP REPLACEMENT STUDIES N Measure Pooled effect size Confidence Interval P-value I2(%) τ2
(A + B) Any wound infiltration analgesia + usual anaesthesia vs Usual anaesthesia    
  Pain at rest at 24 h 12 SMD -0.605 ( -1.051, -0.160) 0.0078 89 0.541
  Pain during activity at 24 h 9 SMD -0.848 ( -1.450, -0.246) 0.0058 92 0.765
  Pain at rest at 48 h 11 SMD -0.285 ( -0.520, -0.050) 0.018 58 0.09
  Pain during activity at 48 h 8 SMD -0.432 ( -0.776, -0.089) 0.014 71 0.171
  Length of hospital stay 9 MD -0.829 ( -1.540, -0.118) 0.022 84 0.866
(A) Wound infiltration analgesia + usual analgesia vs Usual anaesthesia    
  Pain at rest 24 h post-op 7 SMD -0.633 ( -1.208, -0.059) 0.031 90 0.529
  Pain during activity 24 h post-op 4 SMD -0.241 ( -0.637, 0.155) 0.23 68 0.11
  Pain at rest 48 h post-op 6 SMD -0.134 ( -0.348, 0.080) 0.22 19 0.014
  Pain during activity 48 h post-op 3 SMD -0.225 ( -0.559, 0.109) 0.19 35 0.03
  Length of Hospital Stay 5 MD -0.257 ( -0.622, 0.108) 0.17 14 0.029
(B) Wound infiltration analgesia + post closure analgesia + usual anaesthesia vs Usual anaesthesia   
  Pain at rest 24 h post-op 5 SMD -0.572 ( -1.383, 0.240) 0.17 90 0.767
  Pain during activity 24 h post-op 5 SMD -1.378 ( -2.499, -0.257) 0.016 94 1.525
  Pain at rest 48 h post-op 5 SMD -0.489 ( -0.963, -0.015) 0.043 73 0.209
  Pain during activity 48 h post-op 5 SMD -0.599 ( -1.158, -0.040) 0.036 80 0.319
  Length of Hospital Stay 4 MD -1.117 ( -2.474, 0.239) 0.11 88 1.621
TOTAL KNEE REPLACEMENT STUDIES N Measure Pooled effect size Confidence Interval P-value I2 (%) τ2
(A + B) Any wound infiltration analgesia + usual anaesthesia vs Usual anaesthesia    
  Pain at rest at 24 h 12 SMD -0.398 ( -0.576, -0.219) p < 0.001 32 0.032
  Pain during activity at 24 h 12 SMD -0.453 ( -0.671, -0.235) p < 0.001 54 0.078
  Pain at rest at 48 h 12 SMD -0.325 ( -0.546, -0.103) 0.0041 56 0.084
  Pain during activity at 48 h 11 SMD -0.273 ( -0.500, -0.046) 0.018 56 0.081
  Length of hospital stay 8 MD -0.866 ( -1.622, -0.109) 0.025 77 0.805
(A) Wound infiltration analgesia with no additional post closure analgesia + usual anaesthesia vs Usual anaesthesia
  Pain at rest 24 h post-op 6 SMD -0.248 ( -0.452, -0.044) 0.017 14 0.009
  Pain during activity 24 h post-op 6 SMD -0.283 ( -0.470, -0.096) 0.0031 0 0
  Pain at rest 48 h post-op 6 SMD -0.155 ( -0.458, 0.148) 0.32 61 0.086
  Pain during activity 48 h post-op 6 SMD -0.077 ( -0.263, 0.110) 0.42 0 0
  Length of Hospital Stay 1 MD 0.092 ( -0.890, 1.073) 0.85 100 p < 0.001
(B) Wound infiltration analgesia + post wound closure analgesia + usual anaesthesia vs Usual anaesthesia  
  Pain at rest 24 h post-op 6 SMD -0.587 ( -0.829, -0.346) p < 0.001 9 0.008
  Pain during activity 24 h post-op 6 SMD -0.693 ( -1.152, -0.234) 0.0031 74 0.24
  Pain at rest 48 h post-op 6 SMD -0.52 ( -0.778, -0.262) p < 0.001 21 0.022
  Pain during activity 48 h post-op 5 SMD -0.594 ( -0.997, -0.191) 0.0039 61 0.128
  Length of Hospital Stay 7 MD -1.023 ( -1.822, -0.224) 0.012 76 0.761
(C) Wound infiltration analgesia + post wound closure analgesia + usual anaesthesia vs Femoral nerve block + usual anaesthesia
  Pain at rest 24 h post-op 3 SMD 0.253 ( -0.514, 1.021) 0.52 81 0.37
  Pain during activity 24 h post-op 3 SMD 0 ( -0.317, 0.317) 1 0 0
  Pain at rest 48 h post-op 2 SMD 0.254 ( -0.429, 0.937) 0.47 67 0.166
  Pain during activity 48 h post-op 2 SMD -0.073 ( -0.446, 0.299) 0.7 0 0
  Length of Hospital Stay 2 MD 0.07 ( -0.838, 0.978) 0.88 0 0
(D) Wound infiltration analgesia + Femoral nerve block + usual analgesia vs Femoral nerve block + usual anaesthesia
  Pain at rest 24 h post-op 3 SMD -0.241 ( -0.604, 0.122) 0.19 44 0.046
  Pain during activity 24 h post-op 0       
  Pain at rest 48 h post-op 1 SMD -0.18 ( -0.571, 0.211) 0.37 100 0
  Pain during activity 48 h post-op 1 SMD 0.094 ( -0.296, 0.485) 0.64 100 0
  Length of Hospital Stay 1 MD 1.52 ( 0.054, 2.986) 0.042 100 0
(E) Wound infiltration analgesia + usual anaesthesia vs Femoral nerve block + usual anaesthesia   
  Pain at rest 24 h post-op 3 SMD -0.076 ( -0.632, 0.480) 0.79 69 0.166
  Pain during activity 24 h post-op 3 SMD 0.159 ( -0.869, 1.187) 0.76 90 0.741
  Pain at rest 48 h post-op 2 SMD 0.056 ( -0.300, 0.412) 0.76 0 0
  Pain during activity 48 h post-op 2 SMD -0.202 ( -1.034, 0.631) 0.63 75 0.275
  Length of Hospital Stay 2 MD -0.069 ( -0.634, 0.497) 0.81 0 0
  1. N: Number of studies in meta-analysis. Two studies (Essving 2011, Parvataneni 2007 hip and knee) reported mean pain scores for the first 48 hours. These data were duplicated for the 24 and 48 hour outcomes. One study (Andersen LJ, 2007) reported WOMAC pain scores, a composite measure of pain taken at rest and during activity. These data were duplicated for rest and during activity outcomes.