title: Comparison of periarticular anesthesia with liposomal bupivacaine with femoral nerve block for pain control after total knee arthroplasty: A PRISMA-compliant meta-analysis.
abstract: BACKGROUND
  Periarticular anesthesia (PAI) with liposomal bupivacaine (LB) and femoral nerve block (FNB) were 2 common type of pain management after total knee arthroplasty (TKA). There is no consensus about PAI with LB shows better clinical outcome than FNB. Thus, we performed a systematic review and meta-analysis to compare the efficacy and safety of PAI with LB and FNB for patients prepared for TKA.
  
  
  METHODS
  Randomized controlled trials (RCTs) and non-RCTs from PubMed (1966-2017.2), EMBASE (1980-2017.2), and the Cochrane Central Register of Controlled Trials (CENTRAL, 2017.2), Web of Science (1966-2017.2), and Chinese Wanfang database (1980-2017.2) were searched. Continuous outcomes including visual analogue scale (VAS) at 24, 48, and 72 hours, total morphine consumption, length of hospital, and range of motion (ROM) were reported as the weighted mean difference with 95% and confidence interval (CI) and discontinuous outcomes (the occurrence of postoperative nausea and vomiting [PONV]) were presented as relative risk with 95% CI. Random-effects model was adopted to analyze the relevant data.
  
  
  RESULTS
  According to the inclusion and exclusion criteria, 8 studies with 2407 patients were eligible and finally included in this meta-analysis (LB = 1114, FNB = 1293). There was no significant difference between VAS at 24, 4, and 72 hours, ROM, and the occurrence of PONV between PAI with LB group versus FNB group (P > 0.05). Compared with the FNB group, PAI with LB was associated with a significant decrease in length of hospital stay by 0.43 day (MD = -0.43; 95% CI -0.60 to -0.27; P = 0.001) and the total dose of total morphine consumption by (MD = -29.32; 95% CI -57.55 to -1.09; P = 0.042).
  
  
  CONCLUSIONS
  The review of trials found that PAI with LB provided a significant beneficial effect over FNB in improving the pain or decreased the total morphine consumption in patients who underwent TKA. However, PAI with LB associated with less LOS than FNB. More high quality RCTs are still needed to identify the effects and optimal dose of LB for pain management after TKA.
authors.affiliation: Department of Anaesthesiology, Wenzhou People's Hospital, Canghou Xiang, Wenzhou, Zhejiang province, China Department of Anaesthesiology, Wenzhou Central Hospital, Dajian Xiang, Wenzhou, Zhejiang Province, China.
authors.forename: Shu-Qun
authors.initials: SQ
authors.lastname: Liu
authors.forename: Xiang
authors.initials: X
authors.lastname: Chen
authors.forename: Chen-Chen
authors.initials: CC
authors.lastname: Yu
authors.forename: Cheng-Wei
authors.initials: CW
authors.lastname: Weng
authors.forename: Yan-Qin
authors.initials: YQ
authors.lastname: Wu
authors.forename: Jun-Cheng
authors.initials: JC
authors.lastname: Xiong
authors.forename: Shi-Hao
authors.initials: SH
authors.lastname: Xu
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine / Q000008:administration & dosage*; D005267:Femoral Nerve; D006801:Humans; D007902:Length of Stay; D008081:Liposomes; D009020:Morphine / Q000008:administration & dosage; D009294:Narcotics / Q000008:administration & dosage; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D016059:Range of Motion, Articular
chemical_list: D000779:Anesthetics, Local; D008081:Liposomes; D009294:Narcotics; D009020:Morphine; D002045:Bupivacaine