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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(%)

Ï„2

(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 (%)

Ï„2

(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.
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BMC Musculoskeletal Disorders

ISSN: 1471-2474

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