Meta-analysis ranks efficacy of pain management modalities for total knee

Editor's Note

The combination of femoral and sciatic nerve blocks is the overall best approach to pain management after total knee arthroplasty, finds this meta-analysis.

The best five modalities for pain at rest were: femoral/obturator, femoral/sciatic/obturator, lumbar plexus/sciatic, femoral/sciatic, and fascia iliaca compartment blocks.

For reducing opioid consumption, the best five were: femoral/sciatic/obturator, femoral/obturator, lumbar plexus/sciatic, lumbar plexus, and femoral/sciatic blocks.

The best for range of motion were femoral/sciatic blocks.

Blocking multiple nerves was preferable to blocking any single nerve, periarticular infiltration, or epidural analgesia, with femoral/sciatic being the best, the researchers conclude.

A Network Meta-analysis of 170 Randomized Controlled Trials