2025 ISAKOS Biennial Congress ePoster
Single-Shot Femoral Nerve Block Versus Local Infiltration Analgesia For Patients Undergoing Total Knee Arthroplasty: A Systematic Review And Meta-Analysis
André Richard Da Silva Oliveira Filho, Student, Joao Pessoa, Paraiba BRAZIL
Elcio Machinski, md BRAZIL
Vinícius Furtado, Student, Londrina, Paraná BRAZIL
Rodrigo Conde, MS ARGENTINA
Bruno Butturi Varone, MD, Sao Paulo BRAZIL
Riccardo Gomes Gobbi, MD, PhD, São Paulo, SP BRAZIL
Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Daniel Leal, MD, São Paulo, SP BRAZIL
Universidade de São Paulo (USP), São Paulo, São Paulo, BRAZIL
FDA Status Not Applicable
Summary
FNB vs LIA for TKA
ePosters will be available shortly before Congress
Abstract
Introduction
Total knee arthroplasty (TKA) is a common surgical procedure with a rising prevalence, particularly due to an aging population. Early postoperative rehabilitation is crucial for favorable long-term outcomes, necessitating effective analgesic strategies. Femoral nerve block (FNB) and local infiltration analgesia (LIA) are widely utilized for pain management. However, the relative efficacy of single-shot femoral nerve block (sFNB) versus LIA remains unclear due to mixed study results. This study aims to conduct a systematic review and meta-analysis to address these uncertainties.
Methods
This systematic review and meta-analysis adhered to Cochrane and PRISMA guidelines, focusing exclusively on prospective randomized clinical trials (RCTs) that compared sFNB with LIA in TKA patients. A comprehensive literature search was performed using Medline, Cochrane Library, and Embase databases. Data were extracted on postoperative pain scores, opioid consumption, length of hospital stay, time to ambulation, range of motion, and nausea. The mean differences (MD) and risk ratios (RR) were pooled with 95% confidence intervals (CI) for continuous outcomes and categorical outcomes, respectively. Heterogeneity was assessed by I2 statistics. The RoB2 tool was employed to evaluate the risk of bias.
Results
The systematic search yielded 922 studies, of which 14 RCTs were included in the meta-analysis, encompassing a total of 1,321 patients - 657 in the LIA group and 664 in the sFNB group. There were no statistically significant differences between the groups in terms of early postoperative pain scores (MD = 0.18; 95% CI: -0.13 to 0.50; p = 0.26; I² = 55%), opioid consumption (MD = 1.75; 95% CI: -2.67 to 6.17; p = 0.44; I² = 84%), time to ambulation (MD = 12.53; 95% CI: -11.75 to 36.80; p = 0.31; I² = 100%), and incidence of nausea (RR = 0.94; 95% CI: 0.60 to 1.46; p = 0.783; I² = 0%). However, the LIA group showed significant improvement in range of motion (MD = -7.34; 95% CI: -9.91 to -4.83; p < 0.01; I² = 0%) and a reduced length of hospital stay (MD = 0.23; 95% CI: 0.06 to 0.41; p < 0.01; I² = 0%).
Conclusions
The LIA group demonstrated superior range of motion and shorter hospital stays compared to the sFNB group. However, no significant differences were observed for other evaluated outcomes. Further studies utilizing standardized analgesia protocols and multimodal analgesia approaches are necessary to more accurately compare LIA and sFNB in the context of TKA, in order to identify if there are any differences in pain controlling.