Evidence map›Paper›PMID 28663395›Full record

Trial reportThe bone & joint journal2017

A pragmatic randomised controlled trial comparing the efficacy of a femoral nerve block and periarticular infiltration for early pain relief following total knee arthroplasty.

P D H Wall, N R Parsons, H Parsons, J Achten, S Balasubramanian, P Thompson, M L Costa, , P. D. H. Wall on behalf of A. P. Sprowson,† M. L. Costa, PAKA Study Group

Erratum issuedAbstract readComparative StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The bone & joint journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Tourniquet use for knee replacement surgery.The Cochrane database of systematic reviews · 2020
    Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Article
  6. Review
  7. Article
  8. Article
  9. Article
  10. Article
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  12. Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1).Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2020
    Review
  13. Review
  14. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

P D H WallClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK .
N R ParsonsWarwick Medical School, Coventry, CV4 7AL, UK.
H ParsonsClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK .
J AchtenWarwick Clinical Trials Unit, Warwick Medical School, Coventry, CV4 7AL and NDORMs, Oxford University, Oxford, OX3 7LD, UK.
S BalasubramanianUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
P ThompsonUniversity Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
M L CostaNDORMs, Oxford University, Oxford, OX3 7LD, UK.
, P. D. H. Wall on behalf of A. P. Sprowson,† M. L. Costa, PAKA Study Group

Funding

Department of Health PB-PG-0212-27098
6 · The paper itself

Abstract

aimsThe aim of this study was to compare the effectiveness of a femoral nerve block and a periarticular infiltration in the management of early post-operative pain after total knee arthroplasty (TKA). PATIENTS AND

methodsA pragmatic, single centre, two arm parallel group, patient blinded, randomised controlled trial was undertaken. All patients due for TKA were eligible. Exclusion criteria included contraindications to the medications involved in the study and patients with a neurological abnormality of the lower limb. Patients received either a femoral nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol and 0.25 mg of adrenaline all diluted with 0.9% saline to make a volume of 150 ml.

resultsA total of 264 patients were recruited and data from 230 (88%) were available for the primary analysis. Intention-to-treat analysis of the primary outcome measure of a visual analogue score for pain on the first post-operative day, prior to physiotherapy, was similar in both groups. The mean difference was -0.7 (95% confidence interval (CI) -5.9 to 4.5; p = 0.834). The periarticular group used less morphine in the first post-operative day compared with the femoral nerve block group (74%, 95% CI 55 to 99). The femoral nerve block group reported 39 adverse events, of which 27 were serious, in 31 patients and the periarticular group reported 51 adverse events, of which 38 were serious, in 42 patients up to six weeks post-operatively. None of the adverse events were directly attributed to either of the interventions under investigation.

conclusionPeriarticular infiltration is a viable and safe alternative to femoral nerve block for the early post-operative relief of pain following TKA. Cite this article:

Indexed as

Arthroplasty, Replacement, KneeFemoral NerveAgedAnalgesics, OpioidAnesthetics, LocalAnti-Inflammatory Agents, Non-SteroidalBupivacaineEpinephrineFemaleHumansInjections, Intra-ArticularKetorolacLevobupivacaineMaleMorphineNerve BlockAnalgesics, OpioidAnesthetics, LocalAnti-Inflammatory Agents, Non-SteroidalBupivacaineEpinephrineKetorolacLevobupivacaineMorphineFemoral nerve blockPeriarticular infiltrationRandomised controlled trialTotal knee arthroplasty

Identifiers

PMID28663395
PMCPMC5633832

What OpenQuestion holds

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Registered trials

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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.