Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature
Authors: Memtsoudis Stavros G , Cozowicz Crispiana , Bekeris Janis , Bekere Dace , Liu Jiabin , Soffin Ellen M , Mariano Edward R , Johnson Rebecca L , Go George , Hargett Mary J , Lee Bradley H , Wendel Pamela , Brouillette Mark , Kim Sang Jo , Baaklini Lila , Wetmore Douglas S , Hong Genewoo , Goto Rie , Jivanelli Bridget , Athanassoglou Vassilis , Argyra Eriphili , Barrington Michael John , Borgeat Alain , De Andres Jose , El-Boghdadly Kariem , Elkassabany Nabil M , Gautier Philippe , Gerner Peter , Gonzalez Della Valle Alejandro , Goytizolo Enrique , Guo Zhenggang , Hogg Rosemary , Kehlet Henrik , Kessler Paul , Kopp Sandra , Lavand"homme Patricia , Macfarlane Alan , MacLean Catherine , Mantilla Carlos , McIsaac Dan , McLawhorn Alexander , Neal Joseph M , Parks Michael , Parvizi Javad , Peng Philip , Pichler Lukas , Poeran Jashvant , Poultsides Lazaros , Schwenk Eric S , Sites Brian D , Stundner Ottokar , Sun Eric C , Viscusi Eugene , Votta-Velis Effrossyni Gina , Wu Christopher L , YaDeau Jacques , Sharrock Nigel E 
Published: August 2021

Background

Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery.

Methods

A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.

Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.

The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations.

Results

Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92).

Conclusions

Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes.

Recommendation: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.