Safety of femoral nerve block for postoperative analgesia of total knee arthroplasty: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

CHENG Xu ¹ , ZHENG Linli ² , XU Yi ¹ , WU Jiahui ¹ ,  ZHANG Wensheng ^1,3

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. West China School of Medicine, Sichuan University, Chengdu, 610041, P.R.China;
3. Laboratory of Anesthesia and Critical Care, Emergency Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

ZHANG Wensheng, Email: zhangws@vip.163.com

Keywords：

Femoral nerve block; Intravenous opioids patient controlled analgesia; Local infiltration analgesia; Adductor canal block; Total knee arthroplasty; Overview of systematic reviews

DOI：

10.7507/1672-2531.201702061

Video：

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Objectives To overview the systematic reviews/meta-analyses of safety of femoral nerve block (FNB) used as a postoperative analgesic technique in patients undergoing total knee arthroplasty (TKA). Methods We searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, and VIP from inception to July, 2016. Two reviewers independently screened literature, extracted data and used AMSTAR to evaluate the methodological quality of the included studies. The major indexes used to evaluate the safety of FNB were the incidence rates of symptoms including nausea, vomiting, sedation, retention of urine, dizziness, pruritus, hypotension, falls, nenous thromboembolism and deep infection. Results A total of 12 systematic reviews/meta-analyses were included.They assessed the safety of FNB compared with local infiltration analgesia (LIA), periarticular multimodal drug injection (PMDI), epidural analgesia (EA), patient-controlled intravenous analgesia of opioids (PCA) and adductor canal block (ACB), respectively. The methodological quality of included studies were medium, with the scores between 3 to 10. The results of overview indicated that: FNB had lower incidence rates of nausea and vomiting compared with EA and PCA, but had higher than ACB. FNB had lower incidence rates of sedation and retention of urine compared with EA and PCA. FNB had lower incidence rates of dizziness compared with EA and PCA, and lower incidence rate of hypotension compared with EA. Conclusion Current evidence suggests that FNB is safer than EA and PCA. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.

Citation： CHENG Xu, ZHENG Linli, XU Yi, WU Jiahui, ZHANG Wensheng. Safety of femoral nerve block for postoperative analgesia of total knee arthroplasty: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2017, 17(5): 522-528. doi: 10.7507/1672-2531.201702061 Copy

1.	?Beswick AD, Wylde V, Gooberman-Hill R, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open, 2012, 2(1): e000435.
2.	Maheshwari AV, Blum YC, Shekhar L, et al. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res, 2009, 467(6): 1418-1423.
3.	Qin P, Min S, Peng L, et al. Continuous femoral nerve block versus patient-controlled intravenous analgesia for patients undergoing unilateral total knee arthroplasty: a cost-effectiveness analysis and cost-utility analysis. J Anesth Perioper Med, 2016, 3(4): 160-170.
4.	Halawi MJ, Grant SA, Bolognesi MP. Multimodal analgesia for total joint arthroplasty. Orthopedics, 2015, 38(7): e616-625.
5.	熊俊, 陳日新. 系統評價/Meta分析方法學質量的評價工具AMSTAR. 中國循證醫學雜志, 2011, 11(9): 1084-1089.
6.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
7.	Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology, 2010, 113(5): 1144-1162.
8.	Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth, 2008, 100(2): 154-164.
9.	Chan EY, Fransen M, Parker DA, et al. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev, 2014, (5): CD009941.
10.	Kuang MJ, Xu LY, Ma JX, et al. Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: A meta-analysis. Int J Surg, 2016, 31: 17-24.
11.	Yun XD, Yin XL, Jiang J, et al. Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res, 2015, 101(5): 565-569.
12.	Dong CC, Dong SL, He FC. Comparison of adductor canal block and femoral nerve block for postoperative pain in total knee arthroplasty: a systematic review and meta-analysis. Medicine, 2016, 95(12): e2983.
13.	Li D, Ma GG. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2614-2619.
14.	Wang C, Cai XZ, Yan SG. Comparison of Periarticular Multimodal Drug Injection and Femoral Nerve Block for Postoperative Pain Management in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty, 2015, 30(7): 1281-1286.
15.	黃天豐, 張揚, 方向志. 股神經阻滯用于全膝關節置換術患者術后鎮痛的Meta分析. 國際麻醉學與復蘇雜志, 2016, 37(3): 230-235.
16.	余光書, 林焱斌, 黃顯貴. 連續股神經阻滯鎮痛與自控靜脈鎮痛在全膝關節置換術后鎮痛的 Meta 分析. 中國矯形外科雜志, 2014, 22(16): 1441-1448.
17.	袁志明, 魏建仝, 溫景榮. 全膝關節置換后持續股神經阻滯與持續硬膜外鎮痛的Meta分析. 中國組織工程研究, 2015, 19(35): 5728-5734.
18.	張啟棟, 劉朝暉, 程立明. 全膝關節置換應用股神經阻滯鎮痛與自控靜脈鎮痛的系統評價. 中國組織工程研究, 2013, 17(17): 3073-3080.
19.	Klasen J, Junger A, Hartmann B, et al. Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Anesth Analg, 2003, 96(5): 1491-1495, table of contents.
20.	Ezri T, Zahalka I, Zabeeda D, et al. Similar incidence of hypotension with combined spinal-epidural or epidural alone for knee arthroplasty. Can J Anaesth, 2006, 53(2): 139-145.
21.	Ganesh A, Maxwell LG. Pathophysiology and management of opioid-induced pruritus. Drugs, 2007, 67(16): 2323-2333.
22.	Kurita GP, Sjogren P, Ekholm O, et al. Prevalence and predictors of cognitive dysfunction in opioid-treated patients with cancer: a multinational study. J Clin Oncol, 2011, 29(10): 1297-1303.
23.	Thomas K, Chow K, Kirby RS. Acute urinary retention: a review of the aetiology and management. Prostate Cancer Prostatic Dis, 2004, 7(1): 32-37.
24.	Verhamme KM, Sturkenboom MC, Stricker BH, et al. Drug-induced urinary retention: incidence, management and prevention. Drug Saf, 2008, 31(5): 373-388.
25.	Wiffen PJ, Derry S, Moore RA. Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane Database Syst Rev, 2014, (5): CD011056.
26.	Chen YP, Chen SR, Pan HL. Systemic morphine inhibits dorsal horn projection neurons through spinal cholinergic system independent of descending pathways. J Pharmacol Exp Ther, 2005, 314(2): 611-617.
27.	Meyboom RH, Brodie-Meijer CC, Diemont WL, et al. Bladder dysfunction during the use of tramadol. Pharmacoepidemiol Drug Saf, 1999, 8(Suppl 1): S63-64.
28.	Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth, 2005, 95(5): 584-591.
29.	Elkassabany NM, Antosh S, Ahmed M, et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg, 2016, 122(5): 1696-1703.
30.	Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg, 2010, 111(6): 1552-1554.
31.	Kim DH, Lin Y, Goytizolo EA, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology, 2014, 120(3): 540-550.
32.	Jaeger P, Nielsen ZJ, Henningsen MH, et al. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology, 2013, 118(2): 409-415.

1. ?Beswick AD, Wylde V, Gooberman-Hill R, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open, 2012, 2(1): e000435.
2. Maheshwari AV, Blum YC, Shekhar L, et al. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res, 2009, 467(6): 1418-1423.
3. Qin P, Min S, Peng L, et al. Continuous femoral nerve block versus patient-controlled intravenous analgesia for patients undergoing unilateral total knee arthroplasty: a cost-effectiveness analysis and cost-utility analysis. J Anesth Perioper Med, 2016, 3(4): 160-170.
4. Halawi MJ, Grant SA, Bolognesi MP. Multimodal analgesia for total joint arthroplasty. Orthopedics, 2015, 38(7): e616-625.
5. 熊俊, 陳日新. 系統評價/Meta分析方法學質量的評價工具AMSTAR. 中國循證醫學雜志, 2011, 11(9): 1084-1089.
6. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
7. Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology, 2010, 113(5): 1144-1162.
8. Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth, 2008, 100(2): 154-164.
9. Chan EY, Fransen M, Parker DA, et al. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev, 2014, (5): CD009941.
10. Kuang MJ, Xu LY, Ma JX, et al. Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: A meta-analysis. Int J Surg, 2016, 31: 17-24.
11. Yun XD, Yin XL, Jiang J, et al. Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res, 2015, 101(5): 565-569.
12. Dong CC, Dong SL, He FC. Comparison of adductor canal block and femoral nerve block for postoperative pain in total knee arthroplasty: a systematic review and meta-analysis. Medicine, 2016, 95(12): e2983.
13. Li D, Ma GG. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2614-2619.
14. Wang C, Cai XZ, Yan SG. Comparison of Periarticular Multimodal Drug Injection and Femoral Nerve Block for Postoperative Pain Management in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty, 2015, 30(7): 1281-1286.
15. 黃天豐, 張揚, 方向志. 股神經阻滯用于全膝關節置換術患者術后鎮痛的Meta分析. 國際麻醉學與復蘇雜志, 2016, 37(3): 230-235.
16. 余光書, 林焱斌, 黃顯貴. 連續股神經阻滯鎮痛與自控靜脈鎮痛在全膝關節置換術后鎮痛的 Meta 分析. 中國矯形外科雜志, 2014, 22(16): 1441-1448.
17. 袁志明, 魏建仝, 溫景榮. 全膝關節置換后持續股神經阻滯與持續硬膜外鎮痛的Meta分析. 中國組織工程研究, 2015, 19(35): 5728-5734.
18. 張啟棟, 劉朝暉, 程立明. 全膝關節置換應用股神經阻滯鎮痛與自控靜脈鎮痛的系統評價. 中國組織工程研究, 2013, 17(17): 3073-3080.
19. Klasen J, Junger A, Hartmann B, et al. Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Anesth Analg, 2003, 96(5): 1491-1495, table of contents.
20. Ezri T, Zahalka I, Zabeeda D, et al. Similar incidence of hypotension with combined spinal-epidural or epidural alone for knee arthroplasty. Can J Anaesth, 2006, 53(2): 139-145.
21. Ganesh A, Maxwell LG. Pathophysiology and management of opioid-induced pruritus. Drugs, 2007, 67(16): 2323-2333.
22. Kurita GP, Sjogren P, Ekholm O, et al. Prevalence and predictors of cognitive dysfunction in opioid-treated patients with cancer: a multinational study. J Clin Oncol, 2011, 29(10): 1297-1303.
23. Thomas K, Chow K, Kirby RS. Acute urinary retention: a review of the aetiology and management. Prostate Cancer Prostatic Dis, 2004, 7(1): 32-37.
24. Verhamme KM, Sturkenboom MC, Stricker BH, et al. Drug-induced urinary retention: incidence, management and prevention. Drug Saf, 2008, 31(5): 373-388.
25. Wiffen PJ, Derry S, Moore RA. Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane Database Syst Rev, 2014, (5): CD011056.
26. Chen YP, Chen SR, Pan HL. Systemic morphine inhibits dorsal horn projection neurons through spinal cholinergic system independent of descending pathways. J Pharmacol Exp Ther, 2005, 314(2): 611-617.
27. Meyboom RH, Brodie-Meijer CC, Diemont WL, et al. Bladder dysfunction during the use of tramadol. Pharmacoepidemiol Drug Saf, 1999, 8(Suppl 1): S63-64.
28. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth, 2005, 95(5): 584-591.
29. Elkassabany NM, Antosh S, Ahmed M, et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg, 2016, 122(5): 1696-1703.
30. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg, 2010, 111(6): 1552-1554.
31. Kim DH, Lin Y, Goytizolo EA, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology, 2014, 120(3): 540-550.
32. Jaeger P, Nielsen ZJ, Henningsen MH, et al. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology, 2013, 118(2): 409-415.

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Safety of femoral nerve block for postoperative analgesia of total knee arthroplasty: an overview of systematic reviews

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