Review Article

Local Anaesthetic Infiltration in Joint Replacement Surgery: What Is Its Role in Enhanced Recovery?

Table 1

Overview of the literature summarising study design.

AuthorStudy designnJoint replacementAnaesthesiaAnalgesia: study groupControl

Vendittoli et al. [14]RCT42KneeSpinalLIA + PCA (275 mg ropivacaine, 30 mg ketorolac, adrenaline) plus 150 mg ropivacaine at 24 hrsPCA
Kerr and Kohan [15]Case series325Hip and KneeMajority SpinalLIA (max 300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus reinjection at 15–20 hrsN/A
Andersen et al. [16]RCT40HipSpinalLIA + PCA (300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus reinjection next morningPCA
Busch et al. [17]RCT64KneeGeneral or regionalLIA + PCA (400 mg ropivacaine, 30 mg ketorolac, 5 mg epimorphine, adrenaline)PCA
Essving et al. [18]RCT48KneeGeneralLIA + PCA (400 mg ropivacaine, 30 mg ketorolac, adrenaline) plus reinjection at 21 hrsPCA
Gómez-Cardero and Rodríguez-Merchán [19]RCT50KneeSpinalLIA (continuous intra-articular infusion 300 mls of 0.2% ropivacaine at 5 ml/hr until empty)Saline infusion
Krenzel et al. [20]RCT66KneeSpinalCFNB + posterior capsule injection + PCA (20 ml 0.2% ropivacaine)CFNB + PCA
Andersen et al. [21]RCT12Knee (bilateral)SpinalLIA + PCA (340 mg ropivacaine, adrenaline) plus reinjection at 8 and 24 hrsPCA
Zhang et al. [22]RCT80KneeGeneralLIA (300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus 48 hrs continuous infusion (ropivacaine, ketorolac)Control 1: LIA (300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus saline infusion Control 2: saline infusion
Chen et al. [23]RCT92HipGeneralLIA + PCA (24 mls 0.5% bupivacaine) plus continuous infusion 2 ml/hrPCA
Andersen et al. [24]RCT16Knee (bilateral)SpinalLIA + PCA (300 mg ropivacaine, adrenaline) plus reinjection 24 hrsPCA
Andersen et al. [25]RCT32KneeSpinalLIA (170 mls 0.2% ropivacaine and adrenaline) + intra- and extra-articular injection ropivacaine and adrenaline at 24 hrsLIA (170 mls 0.2% ropivacaine and adrenaline) + intra-articular injection ropivacaine and adrenaline only at 24 hrs
Spreng et al. [26]RCT102KneeSpinalLIA + PCA (150 mg ropivacaine and adrenaline), subgroup with 30 mg ketorolac and 5 mg morphine Reinjection 24 hrsEpidural + PCA
Andersen et al. [27]RCT80HipSpinalLIA (200 mg ropivacaine, 30 mg ketorolac, adrenaline) plus intra-articular injection at 8 hrsEpidural
Andersen et al. [28]RCT40KneeSpinalLIA + PCA (300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus continuous intra-articular infusion (ropivacaine, ketorolac)Epidural + PCA
Thorsell et al. [29]RCT85KneeSpinal or epiduralLIA (300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus further injection day 1 (bupivacaine-adrenaline)Epidural
Toftdahl et al. [30]RCT80KneeSpinalLIA (300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus intra-articular injection at 10 pm and 10 amCFNB
Carli et al. [31]RCT40KneeSpinalLIA + PCA (300 mg ropivacaine, 45 mg ketorolac, adrenaline) plus intra-articular injectionat 24 hrsCFNB + PCA
Affas et al. [32]RCT40KneeSpinalLIA + PCA (300 mg ropivacaine, 30 mg ketorolac, adrenaline) plus intra-articular infusion at 24 hrsFNB + PCA

LIA: local infiltration analgesia, RCT: randomized controlled trial, PCA: patient controlled analgesia, (C)FNB: (continuous) femoral nerve block, LOS: length of stay.