Trial reportPain2015
Effect of local anaesthetic infiltration on chronic postsurgical pain after total hip and knee replacement: the APEX randomised controlled trials.
Trial report in Pain, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 7 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- What proportion of people have long-term pain after total hip or knee replacement? An update of a systematic review and meta-analysis.BMJ open · 2025Pooled it
- Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery.The bone & joint journal · 2021Pooled it
- Enhanced recovery following hip and knee arthroplasty: a systematic review of cost-effectiveness evidence.BMJ open · 2020Pooled it
- Are perioperative interventions effective in preventing chronic pain after primary total knee replacement? A systematic review.BMJ open · 2019Pooled it
- Post-operative patient-related risk factors for chronic pain after total knee replacement: a systematic review.BMJ open · 2017Pooled it
- Regional analgesia for improvement of long-term functional outcome after elective large joint replacement.The Cochrane database of systematic reviews · 2015Pooled it
- Pooled it
- Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial.BMJ (Clinical research ed.) · 2022Trial
- Outcomes following hip and knee replacement in diabetic versus nondiabetic patients and well versus poorly controlled diabetic patients: a prospective cohort study.Acta orthopaedica · 2018Trial
- No effect of double nerve block of the lateral cutaneous nerve and subcostal nerves in total hip arthroplasty.Acta orthopaedica · 2018Trial
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- Trial
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- Chronic Pain and Stiffness After Total Knee Arthroplasty: A Comprehensive, Phenotype-Based Review of Mechanisms, Diagnosis and Management.Journal of clinical medicine · 2026Review
- Article
- RecUrrent Intra-articular Corticosteroid injections in Osteoarthritis: the RUbICOn mixed-methods study.Health technology assessment (Winchester, England) · 2025Article
- Factors Associated With the Risk of Neuropathic Pain One Year After Total Knee Arthroplasty and the Protective Role of Local Infiltration Analgesia: A Registry-Based Prospective Cohort Study.ACR open rheumatology · 2025Article
- Chronic post-surgical pain after total knee arthroplasty: a narrative review.Perioperative medicine (London, England) · 2024Article
- Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review.International journal of molecular sciences · 2024Review
- Persistence of analgesic usage and opioid consumption in sarcopenic patients undergoing neuraxial anesthesia: a nationwide retrospective cohort study.Pain reports · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
Total hip replacement (THR) and total knee replacement (TKR) are usually effective at relieving pain; however, 7% to 23% of patients experience chronic postsurgical pain. These trials aimed to investigate the effect of local anaesthetic wound infiltration on pain severity at 12 months after primary THR or TKR for osteoarthritis. Between November 2009 and February 2012, 322 patients listed for THR and 316 listed for TKR were recruited into a single-centre double-blind randomised controlled trial. Participants were randomly assigned (1:1) to receive local anaesthetic infiltration and standard care or standard care alone. Participants and outcomes assessors were masked to group allocation. The primary outcome was pain severity on the WOMAC Pain Scale at 12 months after surgery. Analyses were conducted using intention-to-treat and per-protocol approaches. In the hip trial, patients in the intervention group had significantly less pain at 12 months postoperative than patients in the standard care group (differences in means: 4.74; 95% confidence interval [CI]: 0.95-8.54; P = 0.015), although the difference was not clinically significant. Post hoc analysis found that patients in the intervention group were more likely to have none to moderate pain than severe pain at 12 months than those in the standard care group (odds ratio: 10.19; 95% CI: 2.10-49.55; P = 0.004). In the knee trial, there was no strong evidence that the intervention influenced pain severity at 12 months postoperative (difference in means: 3.83; 95% CI: -0.83 to 8.49; P = 0.107). In conclusion, routine use of infiltration could be beneficial in improving long-term pain relief for some patients after THR.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.