Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 7, pp 1956–1963 | Cite as

Local infiltration analgesia following total knee arthroplasty: effect on post-operative pain and opioid consumption—a meta-analysis

  • Renée KeijsersEmail author
  • Rogier van Delft
  • Michel P. J. van den Bekerom
  • Dirk C. A. A. de Vries
  • Richard M. Brohet
  • Peter A. Nolte



Local infiltration analgesia (LIA) is a popular method for decreasing post-operative pain after total knee arthroplasty (TKA). The goal of this meta-analysis is to compare the effect of LIA with placebo on the intensity of post-operative pain and the consumption of opioids.


A search was performed in the PubMed/MEDLINE, Cochrane, EMBASE and TRIP databases. All (quasi)-randomized controlled trials (RCTs) were included. LIA consists of intra-operative infiltration with at least one analgesic component. Data were pooled using Cochrane software.


Seven placebo-controlled RCTs were included, involving 405 TKAs. On the first post-operative day, LIA provides an average decrease in VAS scores at rest of 12.3 % compared to placebo. Six RCTs studied opioid consumption in patients following TKA. There was a decrease in opioid consumption of 14.8 % compared to placebo 24 h after surgery. This suggests a reduced pain perception due to LIA. On the second post-operative day, the effect on both outcome measures was diminished and no longer significant. Heterogeneity between the studies was 71 % for pain and 39 % for opioid consumption (p = 0.002 and p = 0.0005). No major complications were reported with the use of LIA.


LIA might be able to decrease pain and the use of opioids on the first post-operative day following TKA. However, due to the high level of heterogeneity between the studies, no firm conclusions can be drawn.

Level of evidence

Meta-analysis, Level II.


Knee arthroplasty Analgesia Post-operative pain Meta-analysis 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Renée Keijsers
    • 1
    Email author
  • Rogier van Delft
    • 2
  • Michel P. J. van den Bekerom
    • 3
  • Dirk C. A. A. de Vries
    • 4
  • Richard M. Brohet
    • 5
  • Peter A. Nolte
    • 1
  1. 1.Department of Orthopaedic SurgerySpaarne HospitalHoofddorpThe Netherlands
  2. 2.Departement of AnesthesiologyLeids Universitair Medisch CentrumLeidenThe Netherlands
  3. 3.Department of Orthopaedic SurgeryO.L.V.G.AmsterdamThe Netherlands
  4. 4.Department of AnesthesiologySpaarne HospitalHoofddorpThe Netherlands
  5. 5.Research Center Linnaeus InsitituteSpaarne HospitalHoofddorpThe Netherlands

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