Intrathecal versus local infiltration analgesia for pain control in total joint arthroplasty

J Orthop Surg Res. 2020 Mar 18;15(1):110. doi: 10.1186/s13018-020-01627-4.

Abstract

Background: The purpose of this meta-analysis was to assess the efficacy of intrathecal morphine (ITM) analgesia and local infiltration analgesia (LIA) for pain control in total joint arthroplasty (TJA).

Methods: Embase, PubMed, the Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs). All RCTs were comparing intrathecal analgesia and local infiltration analgesia in TJA. Primary outcomes were the visual analog scale (VAS) score with rest or mobilization up to 72 h. Secondary outcomes were the total morphine consumption, length of hospital stay, and morphine-related complications.

Results: Compared with the intrathecal analgesia group, the LIA group was associated with a reduction in VAS score with rest up to 72 h. Moreover, LIA was associated with a decrease in VAS score with mobilization at 6 h, 12 h, 48 h, and 72 h. Moreover, LIA significantly reduced total morphine consumption (weighted mean difference (WMD) = - 15.37, 95% CI - 22.64 to - 8.83, P = 0.000), length of hospital stay (WMD = - 1.39, 95% CI - 1.67 to - 1.11, P = 0.000), and morphine-related complications (nausea and pruritus).

Conclusions: Local infiltration provided superior analgesia and morphine-sparing effects within the first 72 h compared with ITM following TJA.

Keywords: Intrathecal analgesia; Local infiltration analgesia; Meta-analysis; Total joint arthroplasty.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Analgesics, Opioid / administration & dosage
  • Anesthesia, Local / methods*
  • Arthroplasty, Replacement / adverse effects
  • Arthroplasty, Replacement / methods*
  • Humans
  • Injections, Spinal / methods*
  • Length of Stay / trends
  • Morphine / administration & dosage
  • Pain Management / methods*
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Randomized Controlled Trials as Topic / methods

Substances

  • Analgesics, Opioid
  • Morphine