Analgesic Impact of Single-Shot Versus Continuous Femoral Nerve Block After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Efficient pain management after total knee arthroplasty will accelerate functional recovery and reduce the length of hospital stay. The femoral nerve block is increasingly used in clinical practice owing to its favorable analgesic efficacy. However, the effect of continuous femoral nerve block compared to single-shot femoral nerve block remains controversial.
Three databases (Pubmed, Embase and Cochrane Library) were searched for randomized controlled trials up to April 2019. Seven studies with 525 patients were included in this analysis.
The pooled estimates showed that the continuous femoral nerve block could relieve the pain at rest [standardized mean differences with 95% confidence intervals 1.12 (0.63–1.60), I2 = 57%, p < 0.00001] and physical therapy [standardized mean differences with 95% confidence intervals 1.05 (0.47–1.63), I2 = 71%, p = 0.0004] on postoperative day 1 and reduce total morphine consumption on postoperative day 1 [mean differences with 95% confidence intervals 16.15 (13.75–18.54), I2 = 46%, p < 0.00001] and 2 [mean differences with 95% confidence intervals 7.02 (4.82–9.22), I2 = 35%, p < 0.00001]. There is no significant difference in pain scores at rest and physical therapy on postoperative day 2 and 3, in Western Ontario and McMaster University Arthritis Index scores (p = 0.12), the length of hospital stay (p = 0.94) and the incidence of nausea and vomiting (p = 0.09).
We conclude that the continuous femoral nerve block is more effective than single-shot femoral nerve block after total knee arthroplasty, which provides objective evidence of pain management for anesthetists.
KeywordsAnalgesia Femoral nerve block Meta-analysis Pain Total knee arthroplasty
No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the authors.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Shiyi Li and Junchao Zhu designed the study, coordinated the data acquisition, planned the statistical analysis, and wrote the first draft of the manuscript. Jinpeng Zhou helped with the design of the study. Jinpeng Zhou and Xiuyan Li helped in the data acquisition and quality assessment of the included studies. Xiufei Teng, Chenyang Du and Yang Li helped in the data analysis and quality assessment in the study. Junchao Zhu helped to draft and revise the final manuscript. All authors read and approved the final manuscript.
Shiyi Li, Jinpeng Zhou, Xiuyan Li, Xiufei Teng, Yang Li, Chenyang Du and Junchao Zhu have nothing to disclose.
Compliance with Ethics Guidelines
This meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines . It is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. As such, the study was exempt from requiring IRB approval.
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
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