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The Efficacy and Safety of Periarticular Injection in Total Joint Arthroplasty: A Direct Meta-Analysis.
Hannon, Charles P; Fillingham, Yale A; Spangehl, Mark J; Karas, Vasili; Kamath, Atul F; Casambre, Francisco D; Verity, Tyler J; Nelson, Nicole; Hamilton, William G; Della Valle, Craig J.
Afiliação
  • Hannon CP; Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO.
  • Fillingham YA; Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
  • Spangehl MJ; Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ.
  • Karas V; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
  • Kamath AF; Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH.
  • Casambre FD; Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, IL.
  • Verity TJ; Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, IL.
  • Nelson N; Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, IL.
  • Hamilton WG; Anderson Orthopedic Research Institute, Alexandria, VA.
  • Della Valle CJ; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
J Arthroplasty ; 37(10): 1928-1938.e9, 2022 10.
Article em En | MEDLINE | ID: mdl-36162925
BACKGROUND: Periarticular injection (PAI) is administered intraoperatively to help reduce postoperative pain and opioid consumption after primary total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of PAI in primary TJA to support 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 Medicine. METHODS: The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published prior to March 2020 on PAI in TJA. 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 PAI. RESULTS: Three thousand six hundred and ninety nine publications were critically appraised to provide 60 studies regarded as the best available evidence for an analysis. The meta-analysis showed that intraoperative PAI reduces postoperative pain and opioid consumption. Adding ketorolac or a corticosteroid to a long-acting local anesthetic (eg, ropivacaine or bupivacaine) provides an additional benefit. There is no difference between liposomal bupivacaine and other nonliposomal long-acting local anesthetics. Morphine does not provide any additive benefit in postoperative pain and opioid consumption and may increase postoperative nausea and vomiting. There is insufficient evidence to draw conclusions on the use of epinephrine and clonidine. CONCLUSION: Strong evidence supports the use of a PAI with a long-acting local anesthetic to reduce postoperative pain and opioid consumption. Adding a corticosteroid and/or ketorolac to a long-acting local anesthetic further reduces postoperative pain and may reduce opioid consumption. Morphine has no additive effect and there is insufficient evidence on epinephrine and clonidine.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artroplastia do Joelho / Anestésicos Locais Tipo de estudo: Etiology_studies / 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 Locais Tipo de estudo: Etiology_studies / Guideline / Qualitative_research / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article