title: Local infiltration analgesia following total knee arthroplasty: effect on post-operative pain and opioid consumption--a meta-analysis.
abstract: BACKGROUND
  Local infiltration analgesia (LIA) is a popular method for decreasing post-operative pain after total knee arthroplasty (TKA). The goal of this meta-analysis is to compare the effect of LIA with placebo on the intensity of post-operative pain and the consumption of opioids.
  
  
  METHODS
  A search was performed in the PubMed/MEDLINE, Cochrane, EMBASE and TRIP databases. All (quasi)-randomized controlled trials (RCTs) were included. LIA consists of intra-operative infiltration with at least one analgesic component. Data were pooled using Cochrane software.
  
  
  RESULTS
  Seven placebo-controlled RCTs were included, involving 405 TKAs. On the first post-operative day, LIA provides an average decrease in VAS scores at rest of 12.3 % compared to placebo. Six RCTs studied opioid consumption in patients following TKA. There was a decrease in opioid consumption of 14.8 % compared to placebo 24 h after surgery. This suggests a reduced pain perception due to LIA. On the second post-operative day, the effect on both outcome measures was diminished and no longer significant. Heterogeneity between the studies was 71 % for pain and 39 % for opioid consumption (p = 0.002 and p = 0.0005). No major complications were reported with the use of LIA.
  
  
  CONCLUSIONS
  LIA might be able to decrease pain and the use of opioids on the first post-operative day following TKA. However, due to the high level of heterogeneity between the studies, no firm conclusions can be drawn.
  
  
  METHODS
  Meta-analysis, Level II.
authors.affiliation: Department of Orthopaedic Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands, reneekeijsers@gmail.com.
authors.forename: Renée
authors.initials: R
authors.lastname: Keijsers
authors.forename: Rogier
authors.initials: R
authors.lastname: van Delft
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
authors.forename: Dirk C A A
authors.initials: DC
authors.lastname: de Vries
authors.forename: Richard M
authors.initials: RM
authors.lastname: Brohet
authors.forename: Peter A
authors.initials: PA
authors.lastname: Nolte
mesh_terms: D000698:Analgesia / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D020370:Osteoarthritis, Knee / Q000601:surgery*; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local