Background: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to\nevaluate the effect of combined femoral and sciatic nerve block (SNB) versus femoral and local infiltration\nanesthesia (LIA) after total knee arthroplasty (TKA).\nMethods: The electronic databases PubMed, Embase, Cochrane Library, and Web of Science were searched from their\ninception to 15 June 2016. Articles comparing combined femoral and SNB versus femoral and LIA for pain control were\neligible for this meta-analysis. This systematic review and meta-analysis was performed according to the PRISMA\nstatement criteria. The primary endpoint was the visual analogue scale (VAS) score with rest at 12, 24, and 48 h, which\nrepresents the pain control after TKA. Data regarding active knee flexion, length of hospital stay, anesthesia time, and\nmorphine use at 24 and 48 h were also compiled. The complications of postoperative nausea and vomiting (PONV)\nand fall were also noted to assess the safety of morphine-sparing effects. After testing for publication bias and\nheterogeneity across studies, the data were aggregated for random-effects modeling when necessary.\nResults: Seven clinical trials with 615 patients were included in the meta-analysis. The pooled results indicated that\nSNB was associated with a lower VAS score at 12 h (MD = âË?â??6.96; 95% CI âË?â??8.36 to âË?â??5.56; P < 0.001) and 48 h (MD = âË?â??2.\n41; 95% CI âË?â??3.90 to âË?â??0.91; P < 0.001) after TKA. There was no significant difference between the SNB group and the LIA\ngroup in terms of the VAS score at 24 h (MD = 0.67; 95% CI âË?â??0.31 to 1.66; P = 0.182). The anesthesia time in the LIA\ngroup was shorter than in the SNB group, and the difference was statistically significant (MD = 4.31, 95% CI 1.34 to 7.28,\nP = 0.004). There were no significant differences between the groups in terms of active knee flexion, length of hospital\nstay, morphine use, PONV, and the occurrence of falls.\nConclusions: SNB may provide earlier anesthesia effects than LIA when combined femoral nerve block (FNB); however,\nthere were no differences in morphine use, active knee flexion, and PONV between the groups. The LIA group spent\nless time under anesthesia, suggesting that LIA may offer a practical and potentially safer alternative to SNB.
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