title: Potential superiority of periarticular injection in analgesic effect and early mobilization ability over femoral nerve block following total knee arthroplasty.
abstract: OBJECTIVE
  Pain management after total knee arthroplasty (TKA) should permit early knee mobilization with minimal pain. Periarticular injection (PAI) with local anaesthetics has been recently discussed as a protocol of pain control. The purpose of this review of the literature was to evaluate the efficacy of PAI in comparison with femoral nerve block (FNB).
  
  
  METHODS
  A literature search was performed in PubMed, EMBASE, the OVID database and the Cochrane Library databases. Risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included narcotic consumption, pain score, early mobilization ability, length of stay and adverse effects or events.
  
  
  RESULTS
  Research identified 918 articles, of which six with a total of 284 knees, met the inclusion criteria and were eligible for the current study. Conflicting evidence was found in terms of narcotic consumption on the postoperative day 1 and early mobilization ability. Total narcotic consumption, pain score in the first 2 days after surgery, length of stay and adverse effects or events showed no difference between two groups. Lower pain score on the day of surgery was detected after PAI. When compared to continuous FNB, patients in PAI group showed a tendency to achieving better ability of early mobilization.
  
  
  CONCLUSIONS
  In consideration of its relatively simple practice and its potential in analgesic effects or early mobilization ability, PAI had superiority to FNB in the management of pain control after TKA. Before PAI could be widely used in clinical practice after TKAs, further investigations would be necessary to confirm or refute our observed results and to unify the protocol of PAI.
  
  
  METHODS
  I.
authors: Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
authors: Huichao
authors: H
authors: Fu
authors: Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
authors: Jiaxing
authors: J
authors: Wang
authors: Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
authors: Wen
authors: W
authors: Zhang
authors: Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
authors: Tao
authors: T
authors: Cheng
authors: Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. zxl201450@hotmail.com.
authors: Xianlong
authors: X
authors: Zhang
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004434:Early Ambulation; D005267:Femoral Nerve; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000601:surgery; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local
keywords: Femoral nerve block; Pain management; Periarticular injection; Systematic review; Total knee arthroplasty
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