| Li et al.3737 Li J, Dong BH, Wu XC, Xu P. Effect of femoral and sciatic nerve block on the tourniquet reaction and postoperative pain during total knee arthroplasty. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015;37(6):641-4
|
60 patients |
Randomized clinical Trial |
The femoral nerve and the sciatic nerve block applied to the TKA may inhibit the tourniquet reaction, maintaining the hemodynamic stability, reducing the anesthetic dosage and reducing POP. |
| Shen et al.6767 Shen SJ, Peng PY, Chen HP, Lin JR, Lee MS, Yu HP. Analgesic effects of intra-articular bupivacaine/ intravenous parecoxib combination therapy versus intravenous parecoxib monotherapy in patients receiving total knee arthroplasty: a randomized, double-blind trial. Biomed Res Int. 2015;2015:450805.
|
36 patients |
Randomized, double-blind study |
Intra-articular bupivacaine in combination with intravenous parecoxib may improve pain relief and reduce the demand for rescue analgesics in patients undergoing TKA. |
| YaDeau et al.6464 YaDeau JT, Lin Y, Mayman DJ, Goytizolo EA, Alexiades MM, Padgett DE, et al. Pregabalin and pain after total knee arthroplasty: a double-blind, randomized, placebo-controlled, multidose trial. Br J Anaesth. 2015;115(2):285-93.
|
120 patients |
Prospective, randomized, blinded, controlled study |
Pregabalin increased sedation but did not increase patient satisfaction. This study did not support routine perioperative pregabalin for patients with TKA. |
| Olive et al.6565 Olive DJ, Barrington MJ, Simone SA, Kluger R. A randomized controlled study comparing three schemes of analgesia after total knee joint replacement: continuous femoral nerve block, intrathecal morphine or both. Anaest Intensive Care. 2015;43(4):454-60.
|
81 patients |
Randomized clinical trial |
In patients without CFNB, the use of SMI was blinded. 81 patients were randomized. At 24 hours, the SMI-only group reported more pain than the other groups. At 18 to 24 hours, the SMI group used more morphine than other groups. Patients who received SMI had pruritus. There were no significant differences regarding nausea and sedation by SpO2. This study showed that a CFNB resulted in reduced pain, lower morphine consumption and better mobilization in 24h compared to SMI. This study showed no statistically significant differences between CFNB alone and CFNB + SMI. |
| Sarridou et al.6666 Sarridou DG, Chalmouki G, Braoudaki M, Koutsoupaki A, Mela A, Vadalouka A. Intravenous parecoxib and continuous femoral block for postoperative analgesia after total knee arthroplasty. A randomized, double-blind, prospective trial. Pain Physician. 2015;18(3):267-76.
|
90 patients |
Randomized clinical trial |
Intravenous parecoxib in association with the continuous femoral block provided a superior analgesic efficacy and opioid-sparing effects in patients undergoing TKA. |
| Wylde et al. 7272 Wylde V, Lenguerrand E, Gooberman-Hill R, Beswick AD, Marques E, Noble S, et al. Effect of local anesthetic infiltration on chronic postsurgical pain after total hip and knee replacement: APEX randomized clinical trials. Pain. 2015;156(6):1161-70.
|
300 patients |
Randomized clinical trial |
Local anesthetic infiltration reduces chronic pain by up to one year, suggesting that routine use of infiltration could improve long-term pain relief. |
| Frassanito et al.8989 Frassanito L, Messina A, Vergari A, Colombo D, Chierichini A, Della Corte F, et al. Intravenous infusion of magnesium sulfate and postoperative analgesia in total knee arthroplasty. Minerva Anestesiol. 2015;81(11):1184-91.
|
40 patients |
Randomized clinical trial |
Preoperative intravenous administration of Mg did not influence postoperative pain control and analgesic consumption after TKA. |
| Ali et al.4141 Ali A, Sundberg M, Hansson U, Malmvik J, Flivik G. Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty: a randomized double-blind study of 200 patients. Acta Orthop. 2015;86(3):373-7.
|
200 patients |
Double-blind, randomized study |
CIAA had no clinically relevant effect on POP and length of hospital stay. More infections were found in the therapy group and, therefore, the use of CIAA was discontinued. |
| Tonelli Filho5555 Tonelli Filho JR, Passarelli MC, Brito JAS, Campos GC, Zorzi AR, Miranda JB. Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty. Rev Bras Ortop. 2016;51(6):680-6.
|
21 patients |
Prospective clinical trial |
The lateral via provided better postoperative lateral patellar tilt in valgus knee arthroplasties. |
| Shin et al.9090 Shin HJ, Kim EY, Na HS, Kim TK, Kim MH, Do SH. Magnesium sulfate attenuates acute postoperative pain and increased pain intensity after surgical injury in bilateral total knee arthroplasty in staging: a randomized, double-blind, placebo-controlled study. Br J Anaesth. 2016;117(4):497-503.
|
44 patients |
Randomized clinical trial |
Magnesium sulfate administration significantly reduced POP and minimized the difference in pain intensity between the first and second operations. |
| Yun et al.5757 Yun SH, Park JC, Kim SR, Choi YS. Effects of dexmedetomidine on interleukin-6 serum, hemodynamic stability and postoperative pain relief in elderly patients under spinal anesthesia. Acta Med Okayama. 2016;70(1):37-43.
|
45 patients |
Randomized clinical trial |
The results indicate that intravenous perioperative administration of dexmedetomidine decreases postoperative serum IL-6 levels and an optimal analgesic effect. |
| Heo et al.7777 Heo BH, Lee HJ, Lee HG, Kim MY, Park KS, Choi JI, et al. Femoral nerve block for patient undergoing total knee arthroplasty: prospective, randomized, double-blinded study evaluating analgesic effect of perineural fentanyl additive to local anesthetics. Medicine (Baltimore). 2016;95(36):e4771.
|
82 patients |
Double-blind, randomized, prospective study |
Additional fentanyl showed no prominent increase in analgesic effect in the CFNB field after TKA. |
| Jianda et al.5858 Jianda X, Yuxing Q, Yi G, Hong Z, Libo P, Jianning Z. Impact of preemptive analgesia on inflammatory responses and rehabilitation after primary total knee arthroplasty: a controlled clinical study. Sci Rep. 2016;6:30354.
|
75 patients |
Randomized clinical trial |
Preemptive analgesia added to a multimodal analgesic regimen improved analgesia, reduced inflammatory reaction, and accelerated functional recovery in the first postoperative week, but didn't improve long-term function. |
| Gupta et al.7878 Gupta A, Abubaker H, Demas E, Ahrendtsen L. A randomized study comparing the safety and efficacy of intravenous ibuprofen versus ibuprofen and acetaminophen in knee or hip arthroplasty. Pain Physician. 2016;19(6):349-56.
|
78 patients |
Randomized clinical trial |
Ibuprofen IV combined with acetaminophen IV showed additional benefit in terms of improved pain scores only on postoperative day 3, fewer potential adverse events related to opioid use, and less opioid use when compared to ibuprofen IV alone. |
| Sundarathiti et al.8080 Sundarathiti P, Thammasakulsiri J, Supboon S, Sakdanuwatwong S, Piangjai M. Comparison of continuous femoral nerve block (BNFC/SA) and continuous femoral nerve block with mini-dose spinal morphine (BNFC/SAMO) for postoperative analgesia after total knee arthroplasty (TKA): a randomized controlled study. BMC Anesthesiol. 2016;16(1):38.
|
68 patients |
Randomized clinical trial |
Although in some patients CFNB is inadequate, a mini dose of subarachnoid morphine (0.035mg) in addition to CFNB has shown to be effective with minimal adverse effects. |
| Blikman et al. 5050 Blikman T, Rienstra W, van Raaij TM, ten Hagen AJ, Dijkstra B, Zijlstra WP, et al. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty. BMJ Open. 2016;6(3):e010343.
|
59 patients |
Prospective, multicentric, randomized study |
The knowledge gained from this study can potentially improve pain relief and postoperative rehabilitation after TKA. Furthermore, due to an extensive preoperative treatment period, it could provide specific information on the efficacy of duloxetine in patients with advanced hip and knee osteoarthritis with possible NP/CS. |
| Tsukada et al.6363 Tsukada S, Kurosaka K, Maeda T, Iida A, Nishino M, Hirasawa N. Early-stage periarticular injection during total knee arthroplasty may provide a better postoperative pain relief than late-stage periarticular injection: a randomized-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1124-31.
|
77 patients, 67 women and ten men |
Double-blind, randomized clinical trial |
The addition of corticosteroids to the periarticular injection significantly decreased premature POP. Further studies are needed to confirm the safety of corticosteroid in periarticular injection. |
| Wall et al.4242 Wall PDH, Parsons NR, Parsons H, Achten J, Balasubramanian S, Thompson P, et al. PAKA Study Group. A pragmatic randomised controlled trial comparing the efficacy of a femoral nerve block and periarticular infiltration for early pain relief following total knee arthroplasty. Bone Joint J. 2017;99-B(7):904-11.
|
269 patients |
Randomized clinical trial |
Periarticular infiltration is a viable and safe alternative to FNB for immediate POP relief after TKA. |
| Gudmundsdottir et al.7676 Gudmundsdottir S, Franklin JL. Continuous adductor canal block added to local infiltration analgesia (LIA) after total knee arthroplasty has no additional benefits on pain and ambulation on postoperative day 1 and 2 compared with LIA alone. Acta Orthop. 2017;88(5):537-42.
|
69 patients |
Randomized clinical trial |
The results indicated that there is no benefit of continuous infusion of ACB added to a single dose of LIA compared to LIA alone on pain. In addition, ACB showed no superiority in the ability to ambulate at 2 days after the operation. |
| Ortiz-Gómez et al.4444 Ortiz-Gómez JR, Perepérez-Candel M, Vázquez-Torres JM, Rodriguez-Del Río JM, Torrón-Abad B, Fornet-Ruiz I, et al. Postoperative analgesia for elective total knee arthroplasty under subarachnoid anesthesia with opioids: comparison between epidural, femoral block and adductor canal block techniques (with and without perineural adjuvants). A prospective, randomized, clinical trial. Minerva Anestesiol. 2017;83(1):50-8.
|
639 patients |
Randomized, prospective, clinical study |
Peripheral nerve blocks with perineural dexamethasone improve postoperative analgesia of TKA. The addition of dexamethasone to ACB opens new possibilities for improving analgesia of TKA and should be investigated as an alternative to femoral nerve block. |
| Álvarez et al.3838 Álvarez NER, Ledesma RJG, Hamaji A, Hamaji MWM, Vieira JE. Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial. BMC Anesthesiol. 2017;17(1):64.
|
39 patients |
Randomized clinical trial |
CFNB combined with sciatic nerve block provides efficacy in postoperative analgesia in patients undergoing TKA, with lower pain scores after 24 h and lower incidence of adverse effects and bleeding compared to subarachnoid morphine. |
| Canakci, Unal and Guzel8383 Canakci E, Unal D, Guzel Y. The Effect of unilateral spinal anesthesia and psoas compartment with sciatic block on the postoperative pain management in total knee artroplastic surgery. Pain Res Manag. 2017;2017:4127424.
|
60 patients |
Randomized clinical trial |
The technique of SPC blockade with bupivacaine hydrochloride ensured greater hemodynamic efficiency in the perioperative in elderly high-risk patients undergoing TKA. |
| Deng et al. 6868 Deng Y, Jiang TL, Yang XX, Li M, Wang J, Guo XY. Effect of continuous femoral nerve block combined with periarticular local infiltration analgesia on early operative functional recovery after total knee arthroplasty: a randomized, double-blind, controlled study. Beijing Da Xue Xue Bao Yi Xue Ban. 2017;49(1):137-41.
|
100 patients |
Double-blind, randomized, controlled study |
Compared to postoperative analgesia of CFNB alone, CFNB with PALI can relieve pain at rest and pain during passive motion after TKA. CFNB with PALI may shorten the time to perform an active straight leg raise and the capacity time to achieve 90° knee flexion. Thus, some patients could improve postoperative rehabilitation training. |
| Barrington et al.8282 Barrington JW, Emerson RH, Lovald ST, Lombardi AV, Berend KR. No difference in early analgesia between liposomal bupivacaine injection and intrathecal morphine after TKA. Clin Orthop Relat Res. 2017;475(1):94-105.
|
119 patients |
Multicentric, controlled, randomized, prospective study. |
This study showed potential pain control at 6 and 12 h in the LB and subarachnoid morphine groups compared to the ropivacaine group, at the expense of much higher incidences of pruritus (itching) in the subarachnoid morphine group. Based on these results, the use of PAI with LB was preferred as an alternative to spinal anesthesia with subarachnoid morphine as a result of similar control of POP and the potential for reduced adverse events. |
| Jahic et al.5959 Jahic D, Omerovic D, Tanovic AT, Dzankovic F, Campara MT. The effect of prehabilitation on postoperative outcome in patients following primary total knee arthroplasty. Med Arch. 2018;72(6):439-43.
|
20 patients |
Prospective study |
The study proved statistically significant difference between the KS and FS between the intervention and control group at test time: immediately before surgery - meaning that the KS and FS Test increased after the pre-rehabilitation program (6-week home exercise program).
The knee score was significantly different between the two groups observed postoperatively, 3 and 6 months, while the FS was not significantly different in that period. Preoperative home exercises provide better preoperative KS and FS and better KS up to 6 months postoperatively. However, 12 months postoperatively, there was no significant difference between the intervention and control group for the KS and FS. |
| Bugada et al.6262 Bugada D, Allegri M, Gemma M, Ambrosoli AL, Gazzerro G, Chiumiento F, et al. Effects of anaesthesia and analgesia on long-term outcome after total knee replacement: a prospective, observational, multicentre study. Eur J Anaesthesiol. 2017;34(10):665-72.
|
563 patients |
Prospective, observational, multicenter study. |
Continuous regional anesthesia provides analgesic benefit for up to one month after surgery but did not influence PPOP at 6 months. Better pain control at one month was associated with reduced PPOP. Patients with higher expectations regarding the surgery, higher baseline inflammation, and a pessimistic outlook are more likely to develop PPOP. |
| Liu et al.3535 Liu J, Wang F. Preoperative celecoxib analgesia is more efficient and equally tolerated compared to postoperative celecoxib analgesia in knee osteoarthritis patients undergoing total knee arthroplasty: A randomized, controlled study. Medicine (Baltimore). 2018;97(51):e13663.
|
226 patients |
Randomized clinical trial |
The preoperative analgesia group also exhibited decreased GPA scores compared to the postoperative analgesia group at 2, 6, 12, 24 and 48 h after surgery. Most interestingly, patients in the preoperative analgesia group consumed less GPA compared to patients in the postoperative analgesia group 72 h after the operation. No difference in incidence of adverse events was observed between the two groups. |
| O’Neal et al.7979 O'Neal JB, Freiberg AA, Yelle MD, Jiang Y, Zhang C, Gu Y, et al. Intravenous vs oral acetaminophen as an adjunct to multimodal analgesia after total knee arthroplasty: a prospective, randomized, double-blind clinical trial. J Arthroplasty. 2017;32(10):3029-33.
|
174 patients |
Single-center, randomized, double-blind, placebo-controlled clinical trial |
Neither intravenous nor oral acetaminophen provided additional analgesia in the immediate postoperative period when administered as adjunct multimodal analgesia in patients undergoing TKA in the context of spinal anesthesia. |
| Novello-Siegenthaler et al.5252 Novello-Siegenthaler A, Hamdani M, Iselin-Chaves I, Fournier R. Ultrasound-guided continuous femoral nerve block: a randomized trial on the influence of femoral nerve catheter orifice configuration (six-hole versus end-hole) on postoperative analgesia after total knee arthroplasty. BMC Anesthesiol. 2018;18(1):191.
|
80 patients |
Prospective, randomized clinical trial |
In this study, the catheter port configuration did not influence the efficacy of CFNB. In this scenario: the quality of analgesia was similar, without reduction in local anesthetic or morphine consumption and equivalent postoperative quadriceps weakness. |
| Sztain et al.4545 Sztain JF, Khatibi B, Monahan AM, Said ET, Abramson WB, Gabriel RA, et al. Proximal versus distal continuous adductor canal blocks: does varying perineural catheter location influence analgesia? a randomized, subject-masked, controlled clinical trial. Anesth Analg. 2018;127(1):240-6.
|
50 patients |
Randomized clinical trial |
For CACB accompanied by intraoperative periarticular local anesthetic infiltration, analgesia the day after TKA is improved with a catheter inserted at the midpoint level between the anterior superior iliac spine and the superior border of the patella compared to a more distal insertion closer to the adductor hiatus. |
| Wu, Lu and Ma7474 Wu Y, Lu X, Ma Y. Low dose multiple dexamethasone in the perioperative period improves postoperative clinical results after total knee arthroplasty. Musculoskeletal Dis BMC. 2018;19(1):428.
|
50 patients |
Randomized clinical trial |
The administration of 10mg dexamethasone 1h before surgery and repeated at 6h postoperatively can significantly reduce the postoperative CRP and IL-6 level and the incidence of PONV, relieve pain, achieve an additional analgesic effect and improve early ROM compared to the other two groups in TKA. |
| Tan et al.7575 Tan Z, Kang P, Pei F, Shen B, Zhou Z, Yang J. A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage. Medicine (Baltimore). 2018;97(48):e13391.
|
200 patients |
Randomized clinical trial |
MBA does not relieve lateral knee pain in the early stage, but provides similar analgesic effect and better early rehabilitation efficacy compared to FNB in patients undergoing TKA. |
| Bian et al.6969 Bian YY, Wang LC, Qian WW, Lin J, Jin J, Peng HM, et al. Role of parecoxib sodium in the multimodal analgesia after total knee arthroplasty: a randomized double-blinded controlled trial. Orthop Surg. 2018;10(4):321-7.
|
88 patients |
Randomized clinical trial |
In preemptive multimodal analgesia strategies, parecoxib sodium can significantly decrease the VAS score in the short term, relieve pain immediately after surgery, and does not increase the incidence of complications. Parecoxib sodium is a safe and effective drug for the perioperative analgesic treatment of TKA. |
| Shi et al.7070 Shi ZB, Dang XQ. Efficacy of the multimodal perioperative analgesia protocol with periarticular injection of medications and use of non-steroidal anti-inflammatory drugs in total knee arthroplasty. Niger J Clin Pract. 2018;21(9):1221-7.
|
110 patients with ages between 30 and 85 years |
Prospective, randomized clinical trial |
Intraoperative periarticular injection with multimodal drugs significantly relieved pain after surgery and reduced the requirement for NSAIDs. This injection also improved patient satisfaction and joint ROM without apparent risks after TKA. |
| Fransen et al.6060 Fransen BL, Hoozemans MJM, Argelo KDS, Keijser LCM, Burger BJ. Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up. Arch Orthop Trauma Surg. 2018;138 (9):1305-16.
|
50 patients |
Controlled randomized clinical trial |
The fast-track protocol for primary TKA presented significantly lower knee pain scores and improved functional outcome in the first 7 days after TKA compared to a regular protocol. |
| Erkılıç et al.8686 Erkiliç E, Kesimci E, Sahin D, Bektaser B, Yalçin N, Ellik S, Aylin Sepici-Dinçel A. Does preemptive gabapentin modulate the cytokine response in total knee arthroplasty? A placebo-controlled study. Adv Clin Exp Med. 2018;27(4):487-91.
|
52 patients |
Randomized clinical trial |
Although preemptive oral gabapentin administration didn't reduce postoperative pain and analgesic needs during surgery, it attenuated IL-6 production on the first postoperative day. |
| Sargant et al.4747 Sargant SC, Lennon MJ, Khan RJ, Fick D, Robertson H, Haebich S. Extended duration regional analgesia for total knee arthroplasty: a randomised controlled trial comparing five days to three days of continuous adductor canal ropivacaine infusion. Anaesth Intensive Care. 2018;46(3):326-31.
|
86 patients |
Prospective, randomized study |
CACB extended to five days provided superior analgesia and improved quality of recovery postoperatively on days four and five compared to a three-day infusion. This benefit didn't extend beyond the infusion period. No statistically significant differences between groups were identified for other secondary outcome measures |
| Zlotnicki et al.8484 Zlotnicki JP, Hamlin BR, Plakseychuk AY, Levison TJ, Rothenberger SD, Urish KL. Liposomal bupivacaine vs plain bupivacaine in periarticular injection for control of pain and early motion in total knee arthroplasty: a randomized, prospective study. J Arthroplasty. 2018;33(8):2460-4.
|
80 individuals |
Prospective, randomized study |
No significant improvements were observed between the LB and plain bupivacaine injection groups in overall pain reduction, ROM, or total drug use. At 24h, small statistically significant differences in physical therapy pain scores were observed in patients with LB vs plain bupivacaine and control, but these differences didn't persist at long term. Both preparations demonstrated statistically significant improvements in ROM when compared to historical controls, but no differences were observed between preparations.
In general, minimal significant differences were observed between LB and plain bupivacaine at early and late time points. Both preparations of the periarticular injection demonstrated superiority over pain control regimens but were relatively equivalent to each other in direct comparison. |
| Kaczocha et al.2424 Kaczocha M, Azim S, Nicholson J, Rebecchi MJ, Lu Y, Feng T, Romeiser JL, Reinsel R, Rizwan S, Shodhan S, Volkow ND, Benveniste H. Intrathecal morphine administration reduces postoperative pain and peripheral endocannabinoid levels in total knee arthroplasty patients: a randomized clinical trial. BMC Anesthesiol. 2018;18(1):27.
|
42 patients |
Double-blind, prospective, randomized study |
Subarachnoid morphine administration reduced POP 4 h after TKA surgery compared with placebo and reduced postoperative systemic opioid consumption. At baseline, subarachnoid morphine led to a significant reduction in AEA, 2-AG, and OEA levels, but didn't affect PEA or cortisol levels. In patients who received subarachnoid placebo, 2-AG levels were high 4h after surgery, while patients who received subarachnoid morphine presented reductions in AEA, PEA, and OEA when compared to placebo. At 4h after TKA surgery, cortisol levels were significantly high in the placebo group and reduced in those receiving morphine. These results indicated that subarachnoid morphine reduces POP in patients with TKA. Moreover, activation of central opioid receptors negatively modulates endocannabinoid tone, suggesting that potent analgesics may reduce the stimulus for peripheral endocannabinoid production. This study is the first to document the existence of fast communication between the central opioid and peripheral endocannabinoid systems in humans. |
| Koo et al.3636 Koo K, Park DK, Youm YS, Sung DC, Hwang CH. Enhanced reality showing long-lasting analgesia after total knee arthroplasty: prospective, randomized clinical trial. Sci Rep. 2018;8:2343.
|
60 patients |
Blind, parallel, prospective, randomized clinical study |
Analgesia in the two-week therapy group was effective until the third evaluation, while in the other group it was effective only until the second evaluation. The improvement in ROM in the two-week group was also maintained up to the third evaluation. |
| Manassero et al.9292 Manassero A, Fanelli A, Ugues S, Bailo C, Dalmasso S. Oxycodone/naloxone prolonged oral release offers analgesia equivalent to analgesia controlled by a patient with intravenous morphine after total knee replacement. A randomized controlled study. Minerva Anestesiol. 2018;84(9):1016-23.
|
20 patients |
Double-blind, prospective, randomized study |
This study showed that in the immediate postoperative period after TKA, patients who received oral extended-release COOXN had the same better pain control as those who received IVPCA morphine, with a similar degree of PONV. |
| Kanadli et al.3939 Kanadli H, Dogru S, Karaman T, Karaman S, Tapar H, Sahin A, et al. Comparison of the efficacy of femoral nerve block and fascia iliaca compartment block in patients with total knee replacement. Minerva Anestesiol. 2018;84(10):1134-41.
|
100 patients |
Prospective, randomized study |
The VAS level at 24 h was significantly lower in Group I compared to Group II. Analgesic consumption between zero and 30 minutes was lower in Group II than in Group I; however, it was significantly lower at 6-24 hours in Group I compared to Group II. The qor-40 score was significantly higher in Group I than in Group II. FNB provided more potent analgesia in the first six hours after operation. After 6 h, IFCB demonstrated better pain control. The quality of postoperative recovery was higher in patients with IFCB. |
| Jaeger et al.4848 Jaeger P, Baggesgaard J, Sørensen JK, Ilfeld BM, Gottschau B, et al. Adductor canal block with continuous infusion versus intermittent boluses and morphine consumption: a randomized, blinded, controlled clinical trial. Anesth Analg. 2018;126(6):2069-77.
|
107 patients |
Controlled, double-blind, randomized study |
Changing the mode of administration of an ACB from continuous infusion to repeated intermittent boluses didn't decrease opioid consumption, pain, nor mobility. |
| Mont et al.7171 Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized clinical trial. J Arthroplasty. 2018;33(1):90-6.
|
139 patients |
Controlled, double-blind, randomized study |
LIA with LB 266 mg plus bupivacaine hcl significantly reduced opioid use and intensity of pain. These findings support the use of LIA with LB for TKA when early discharge is the objective. |
| Hutchins et al.8585 Hutchins JL, Leiman D, Minkowitz HS, Jove M, DiDonato KP, Palmer PP. An open study of sufentanil sublingual tablet 30 mcg in patients with postoperative pain. Pain Med. 2018;19(10):2058-68.
|
140 patients |
Single-arm, open, multicentric study |
SST 30µg was effective and well tolerated in the treatment of acute moderate to severe POP. |
| Ilfeld et al.5353 Ilfeld BM, Ball ST, Gabriel RA, Sztain JF, Monahan AM, Abramson WB, et al. A feasibility study of percutaneous peripheral nerve stimulation for the treatment of postoperative pain following total knee arthroplasty. Neuromodulation. 2019;22(5):653-60.
|
7 patients |
Prospective clinical trial |
Percutaneous ultrasound-guided SNP is feasible in the immediate perioperative period and can provide analgesia without the undesirable systemic effects of opioids or quadriceps weakness induced by local anesthetic-based peripheral nerve blocks. |
| Alexandersson et al.5454 Alexandersson M, Wang EY, Eriksson S. A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1035-42.
|
81 patients |
Randomized clinical trial |
The hypothesis that rehabilitation-related outcomes would be improved without a tourniquet is not supported by the results. When the results of the study for surgery performed with and without a tourniquet are compared, no clear benefit was observed for either procedure, as the greater amount of pain exhibited by the non-tourniquet group was only evident for a short time and the improved mobility in this group was not observed at a clinically relevant level. |
| Canbek et al.4646 Canbek U, Akgun U, Aydogan NH, Kilinc CY, Uysal AI. Continuous adductor channel block following total knee arthroplasty provides a better analgesia compared to single shot: a prospective randomized controlled trial. Acta Orthop Traumatol Turc. 2019;53(5):334-9.
|
123 patients |
Randomized clinical trial |
The study verified that pain control after TKA was better in those patients treated with CACB compared to those treated with single-dose ACB. Patients treated with CACB also had better ambulation and functional recovery after TKA. |
| Borys et al.4040 Borys M, Domagala M, Wenclaw K, Jarczynska-Domagala J, Czuczwar M. Continuous femoral nerve block is more effective than continuous adductor channel block for treating pain after total knee arthroplasty: A randomized, double-blind, controlled trial. Medicine (Baltimore). 2019;98(39):e17358.
|
85 patients |
Randomized clinical trial |
FNB was associated with less intense perception of pain after TKA. However, ACB was associated with anterior mobility rehabilitation. |
| Iglesias et al.6161 Iglesias SL, Rodríguez-Urmenyi C, Mangupli MM, Pioli I, Gómez J, Allende BL. Continuous intravenous analgesia vs. intermittent for total primary knee replacement: analysis of the quality of pain control, hospital stay and costs. Acta Ortop Mex. 2018:32(3):134-9.
|
42 patients |
Prospective, randomized clinical trial |
The continuous infusion pump of analgesia, compared to the formal intermittent intravenous regimen, presented better pain control, decreasing the patient's perception of pain, improving tolerance to physical therapy, and reducing, on average, 15h of hospitalization and, therefore, the costs of surgery. |
| Matthews et al.9191 Matthews CN, Chen AF, Daryoush T, Rothman RH, Maltenfort MG, Hozack WJ. Does an elastic compression bandage provide any benefit after primary TKA? Clin Orthop Relat Res. 2019;477(1):134-44.
|
57 patients with ages between 40 and 83 years |
Prospective, randomized study |
The application of a compression dressing after TKA did not result in any clinical improvement in limb circumference, ROM, or pain. Based on this study, the belief is that the application of a compressive dressing after TKA neither benefits nor harms the patient. Thus, compression dressings are no longer used for routine primary TKA. |
| Tsukada et al.9393 Tsukada S, Wakui M, Hoshino A. The impact of including corticosteroid in a periarticular injection for pain control after total knee arthroplasty: a double-blind randomised controlled trial. Bone Joint J. 2016;98-B(2):194-200.
|
105 patients |
Prospective, randomized clinical trial |
Advancing the time of the periarticular injection can provide a significant and clinically meaningful improvement in pain after TKA under general anesthesia. |
| Jiang et al.5656 Jiang HH, Jian XF, Shangguan YF, Qing J, Chen LB. Effects of enhanced recovery after surgery in total knee arthroplasty for patients older than 65 years. Orthop Surg. 2019;11(2):229-35.
|
147 patients above 65 years old |
Controlled prospective study |
The ERAS program is safer and more effective in elderly patients with TKA compared to the traditional via. It relieves perioperative pain, improves joint function, and reduces blood transfusion, length of hospital stay, and overall complications without increasing short-term mortality. |
| Iseki et al.4949 Iseki T, Tsukada S, Wakui M, Kurosaka K, Yoshiya S. Percutaneous periarticular multi-drug injection at one day after total knee arthroplasty as a component of multimodal pain management: a randomized control trial. BMC Musculoskelet Disord. 2019;20(1):61.
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47 patients |
Randomized clinical trial |
The addition of percutaneous periarticular injection of multiple drugs the day after TKA may provide better postoperative pain relief. More studies are needed in order to confirm the safety of percutaneous injection. |
| Yu et al.8787 Yu Y, Lin H, Wu Z, Xu P, Lei Z. Perioperative combined administration of tranexamic acid and dexamethasone in total knee arthroplasty-benefit versus harm? Medicine (Baltimore). 2019;98(34):e15852.
|
88 patients |
Randomized clinical trial |
The combined administration of CATXA + Dexa significantly reduced postoperative CRP and IL-6 levels, relieved postoperative pain, improved the incidence of PONV, provided additional analgesic and antiemetic effects, reduced postoperative fatigue, and improved ROM, without increasing the risk of complications in primary TKA. |
| Maniar et al.8888 Maniar RN, Pradhan P, Bhatnagar N, Maniar A, Bidwai R, Bindal P. Role of the suction drain after knee arthroplasty in the tranexamic acid era: a randomized controlled study. Clin Orthop Surg. 2019;11(1):73-81.
|
105 patients |
Prospective, randomized study |
A suction drain significantly reduced opioid consumption during the first 6 hours after TKA. The drain use made no difference to functional outcome at one year postoperatively. Clinical parameters such as swelling, infection and deep vein thrombosis also remained the same. |
| Laoruengthana et al.4343 Laoruengthana A, Jarusriwanna A, Rattanaprichavej P, Rasamimongkol S, Varakornpipat P, Pongpirul K. Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial. BMC Musculoskelet Disord. 2019;20(1):162.
|
48 patients |
Randomized clinical trial |
Reduction of POP and functional recovery from SBTKA with early and late administration of PAMDI were not significantly different. The time interval of PMDI between knees did not confound the comparison between POP and functional recovery in SBTKA. |
| Cicekci et al.5151 Cicekci F, Yildirim A, Önal Ö, Celik JB, Kara I. Ultrasound-guided adductor canal block using levobupivacaine versus periarticular infiltration of levobupivacaine after total knee arthroplasty: a randomized clinical trial. Sao Paulo Med J. 2019;137(1):45-53.
|
80 patients with ages between 40 and 85 years submitted to unilateral TKA |
Prospective, randomized clinical study |
ACB-L was superior to PAI-L in treating pain after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking capacity. |
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