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The Efficacy and Safety of Regional Nerve Blocks in Total Knee Arthroplasty: Systematic Review and Direct Meta-Analysis.
Fillingham, Yale A; Hannon, Charles P; Kopp, Sandra L; Austin, Matthew S; Sershon, Robert A; Stronach, Benjamin M; Meneghini, R Michael; Abdel, Matthew P; Griesemer, Margaret E; Woznica, Anne; Casambre, Francisco D; Nelson, Nicole; Hamilton, William G; Della Valle, Craig J.
Afiliação
  • Fillingham YA; Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Hannon CP; Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri.
  • Kopp SL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
  • Austin MS; Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Sershon RA; Anderson Orthopaedic Research Institute, Alexandria, Virginia.
  • Stronach BM; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  • Meneghini RM; Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, Indiana.
  • Abdel MP; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
  • Griesemer ME; Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois.
  • Woznica A; Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, Illinois.
  • Casambre FD; Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, Illinois.
  • Nelson N; Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, Illinois.
  • Hamilton WG; Anderson Orthopaedic Research Institute, Alexandria, Virginia.
  • Della Valle CJ; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty ; 37(10): 1906-1921.e2, 2022 10.
Article em En | MEDLINE | ID: mdl-36162923
BACKGROUND: Regional nerve blocks are widely used in primary total knee arthroplasty (TKA) to reduce postoperative pain and opioid consumption. The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after TKA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. METHODS: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published before March 24, 2020 on femoral nerve block, adductor canal block, and infiltration between Popliteal Artery and Capsule of Knee in primary TKA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks compared to a control, local peri-articular anesthetic infiltration (PAI), or between regional nerve blocks. RESULTS: Critical appraisal of 1,673 publications yielded 56 publications representing the best available evidence for analysis. Femoral nerve and adductor canal blocks are effective at reducing postoperative pain and opioid consumption, but femoral nerve blocks are associated with quadriceps weakness. Use of a continuous compared to single shot adductor canal block can improve postoperative analgesia. No difference was noted between an adductor canal block or PAI regarding postoperative pain and opioid consumption, but the combination of both may be more effective. CONCLUSION: Single shot adductor canal block or PAI should be used to reduce postoperative pain and opioid consumption following TKA. Use of a continuous adductor canal block or a combination of single shot adductor canal block and PAI may improve postoperative analgesia in patients with concern of poor postoperative pain control.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artroplastia do Joelho / Anestésicos / Bloqueio Nervoso Tipo de estudo: Guideline / Qualitative_research / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artroplastia do Joelho / Anestésicos / Bloqueio Nervoso Tipo de estudo: Guideline / Qualitative_research / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article