Abstract
Backgroud:
Periarticular multimodal drug injection (PMDI) during total knee arthroplasty (TKA) has been reported with promising effects, but some results still remain controversial. Therefore, we conducted a systematic review and meta-analysis based on randomized controlled trials (RCTs) to evaluate the efficiency and safety of PMDI technique in TKA.
Methods:
We systematically conducted an electronic search in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (SCI), and the Chinese Biomedical Literature Database (CBM). Two independent reviewers completed data collection and assessment of methodological quality according to the Cochrane Handbook 5.1. The quality of evidence of outcomes was judged using GRADE criteria. Statistical analysis was performed using the RevMan 5.1 software.
Results:
Ten studies including eight trials with 1216 TKAs in 835 patients met the inclusion criteria. The short-term results of meta-analysis showed that technique of PMDI in TKA was associated with significantly improved pain scores on the day of surgery and postoperative 1 day [MD = −1.07, 95% CI (−1.43, −0.71), p < 0.01], better straight leg raise[OR = 4.02, 95% CI (2.25, 7.18), p < 0.01], reduced narcotic consumption within postoperative 24 hours [MD = −4.83, 95% CI (−6.61, −3.05), p < 0.01], and less rates of nausea or vomiting, and rash or pruritus [OR = 0.34, 95% CI (0.22, 0.55), p < 0.01]. There were no statistically significant differences in operating time [MD = 0.17, 95% CI (−1.48, 1.82), p = 0.84], hospital stay [MD = −0.20, 95% CI (−1.18, 0.79), p = 0.70], wound complication [OR = 0.79, 95% CI (0.31, 2.04), p = 0.63] and deep vein thrombosis [OR = 0.87, 95% CI (0.42, 1.78), p = 0.69] between both groups.
Conclusions:
Periarticular injection with multimodal drugs in TKA has significant short-term advantages in pain relief, functional recovery, and narcotic consumption with fewer rates of complications (nausea or vomiting and rash or pruritus). Further well-designed RCTs are still needed to investigate the long-term efficiency of PMDI in patients undergoing TKA.
