title: Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty.
abstract: BACKGROUND
  Both adductor canal block (ACB) and periarticular infiltration (PI) have been shown to reduce pain after total knee arthroplasty (TKA) without the motor blockade. However, the efficacy and safety of combined ACB with PI (ACB + PI) as compared to PI alone for analgesia after TKA remains controversial. We therefore performed a meta-analysis to compare the effects of ACB + PI with PI alone on pain controll after TKA.
  
  
  METHODS
  PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies comparing ACB + PI with PI alone for TKA patients. The primary outcomes included pain score with rest or activity and morphine consumption. Secondary outcomes were distance walked, length of hospital stay, and postoperative complications. Relevant data were analyzed using RevMan v5.3.
  
  
  RESULTS
  Three studies involving 337 patients were included. Combined ACB with PI was associated with longer distances walked than PI alone (MD = 7.27, 95% CI: 0.43-14.12, P = 0.04) on postoperative day 1. The outcomes of pain, morphine consumption, length of hospital stay, and postoperative complications were not statistically different between the 2 groups (P > 0.05).
  
  
  CONCLUSIONS
  Our meta-analysis suggests that combined ACB with PI may achieve earlier ambulation for patients after TKA without a reduction in analgesia when compared to PI alone in the early postoperative period. There were no significant differences in morphine consumption, length of hospital stay, and postoperative complications between the 2 groups. However, owing to the variation of included studies, no firm conclusions can be drawn.
authors.affiliation: Peking University China-Japan Friendship School of Clinical Medicine Center for Osteonecrosis and Joint Preserving and Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, China.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Ma
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Gao
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.forename: Wanshou
authors.initials: W
authors.lastname: Guo
authors.forename: Zirong
authors.initials: Z
authors.lastname: Li
authors.forename: Weiguo
authors.initials: W
authors.lastname: Wang
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects / Q000294:innervation; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D013848:Thigh / Q000294:innervation
chemical_list: D000700:Analgesics