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Background  This meta-analysis aimed to perform a meta-analysis to evaluate the efficiency and safety between local infiltration analgesia (LIA) and sciatic nerve block (SNB) when combined with femoral nerve block (FNB) after total knee arthroplasty (TKA).    Methods  A systematic search was performed in MEDLINE (1966-2017.04), PubMed (1966-2017.04), Embase (1980-2017.04), ScienceDirect (1985-2017.04), and the Cochrane Library. Only high-quality studies were selected. Meta-analysis was performed using Stata 11.0 software.    Results  Four randomized controlled trials (RCTs) and two non-randomized controlled trials (non-RCTs), including 273 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 12 h (SMD = −0.303, 95% CI −0.543 to −0.064,  P  = 0.013), VAS score at 24 h (SMD = −0.395, 95% CI −0.636 to −0.154,  P  = 0.001), morphine equivalent consumption at 24 h (SMD = −0.395, 95% CI −0.636 to −0.154,  P  = 0.001), and incidence of nausea (RD = 0.233, 95% CI 0.107 to 0.360,  P  = 0.000) and vomiting (RD = 0.131, 95% CI 0.025 to 0.237,  P  = 0.015).    Conclusion  FNB-combined SNB provides superior pain relief and less morphine consumption within the first 24 h compared FNB-combined LIA in total knee arthroplasty. In addition, there were fewer side effects associated with SNB. Because the sample size and the number of included studies were limited, a multicenter RCT is needed to identify the effects of the two kinds of methods and further work must include range of motion analyses and functional test.

journal of orthopaedic surgery and research

Comparison of local infiltration analgesia and sciatic nerve block for pain control after total knee arthroplasty: a systematic review and meta-analysis