Local infiltration analgesia for postoperative pain after hip arthroplasty: a systematic review and meta-analysis.
Postoperative pain after hip arthroplasty (HA) is very common and severe. Currently, use of routine analgesic methods is often accompanied by adverse events (AEs). Local infiltration analgesia (LIA) for controlling pain has been a therapeutic option in many surgical procedures. However, its analgesic efficacy in HA and its safety remain unclear. Data from 9 randomized controlled trials, involving 760 participants, comparing the effect of LIA with that of placebo infiltration or no infiltration on patients undergoing HA were retrieved from an electronic database, and the pain scores, analgesic consumption, and AEs were analyzed. Effects were summarized using weighted mean differences, standardized mean differences, or odds ratio with fixed or random effect models. There was strong evidence of an association between LIA and reduced pain scores at 4 hours at rest (P < .00001) and with motion (P < .00001), 6 hours with motion (P = .02), and 24 hours at rest (P = .01), and decreased analgesic consumption during 0 to 24 hours (P = .001) after HA. These analgesic efficacies for LIA were not accompanied by any increased risk for AEs. However, the current meta-analysis did not reveal any associations between LIA and the reduced pain scores or analgesic consumption at other time points. The results suggest that LIA can be used for controlling pain after HA because of its efficacy in reducing pain scores and thus can reduce analgesic consumption on the first day without increased risk of AEs.


CONCLUSIONS
This is the first pooled database meta-analysis to assess the analgesic effects and safety of LIA in controlling pain after HA. The derived information offers direct evidence that LIA can be used for patients undergoing HA because of its ability to reduce pain scores and analgesic consumption without any additional AEs.
Unit for Evidence Based Medicine, Department of Human Anatomy & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China.
Jun-Bin
JB
Yin
Unit for Evidence Based Medicine, Department of Human Anatomy & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China; Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China.
Guang-Bin
GB
Cui
Unit for Evidence Based Medicine, Department of Human Anatomy & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China; Department of Orthopaedics, Affiliated Hospital of Qinghai University, Xining, PR China.
Ming-Shan
MS
Mi
Unit for Evidence Based Medicine, Department of Human Anatomy & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China; Dental Department of Qinghai Provincial People's Hospital, Xining, PR China.
Yu-Xia
YX
Du
Unit for Evidence Based Medicine, Department of Human Anatomy & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China.
Sheng-Xi
SX
Wu
Unit for Evidence Based Medicine, Department of Human Anatomy & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China.
Yun-Qing
YQ
Li
Unit for Evidence Based Medicine, Department of Human Anatomy & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China. Electronic address: wangwen@fmmu.edu.cn.
Wen
W
Wang
D000698:Analgesia / Q000379:methods*; D001178:Arthroplasty / Q000009:adverse effects*; D004333:Drug Administration Routes; D005279:Fenoprofen / Q000627:therapeutic use*; D006615:Hip / Q000601:surgery; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology
D005279:Fenoprofen
Local infiltration analgesia; hip arthroplasty; meta-analysis; postoperative pain; review