ReviewLiposomal bupivacaine infiltration versus femoral nerve block for pain control in total knee arthroplasty: A systematic review and meta-analysis

- A meta-analysis is performed to evaluate the efficiency of FNB compared with local LB for pain management after TKA.
- Only high quality studies were selected.
- LB infiltration could significantly reduce the morphine equivalents consumption compared FNB.

ObjectiveTotal knee arthroplasty (TKA) usually results in postoperative pain. The objective of this meta-analysis was to compare the effectiveness and safety of liposomal bupivacaine (LB) infiltration and femoral nerve block (FNB) for pain control in total knee arthroplasty.MethodsWe systemically searched electronic databases, including Embase (1980-2016.7), MEDLINE (1966-2016.7), PubMed (1966-2016.7), ScienceDirect (1985-2016.7), Web of Science (1950-2016.7) and Cochrane Library for potentially relevant articles. All calculations were conducted using Stata 11.0.ResultsOne randomized controlled trials (RCTs) and five non-RCTs involving 1289 participants met the inclusion criteria. The result of the meta-analysis revealed that there were no significant differences in terms of postoperative pain scores at POD 0 (SMD = −0.047, 95% CI: -0.276 to 0.182, P = 0.688), POD1 (SMD = −0.038, 95% CI: -0.273 to 0.197, P = 0.749) or POD 2 (SMD = −0.043, 95% CI: -0.192 to 0.107, P = 0.575). Significant differences were found between groups in morphine equivalent consumption at POD 1 (SMD = 0.625, 95% CI: 0.068 to 1.183, P = 0.028) and POD 2 (SMD = 0.410, 95% CI: 0.024 to 0.796, P = 0.037) between groups. There were no significant differences regarding the incidence of adverse effects such as nausea (RD = −0.01, 95% CI: -0.04 to −0.075, P = 0.914) or vomiting (RD = 0.006, 95% CI: -0.049 to 0.062, P = 0.821).ConclusionsLiposomal bupivacaine infiltration provides similar postoperative pain relief to femoral nerve block following total knee arthroplasty. In addition, liposomal bupivacaine infiltration could significantly reduce the consumption of morphine equivalents compared to femoral nerve block without an increased risk of adverse events.