Evidence map›Paper›PMID 36260155›Full record

ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2023

Effect of multiple analgesic pathways including local infiltration analgesia, peripheral nerve blocks, and intrathecal morphine for controlling pain after total knee arthroplasty.

Siriluk Toolyodpun, Artit Laoruengthana, Inthiporn Kositanurit, Surachart Podjanasupawun, Chao Saenghirunvattana, Krit Pongpirul

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.3field-weighted citation impact, top 20% of its field
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

5 citing papers in PubMed, 6 citations in OpenAlex.

  1. Intrathecal nalbuphine at two doses reduces opioid use and pain after total knee arthroplasty: a randomized controlled trial.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

Siriluk ToolyodpunDepartment of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Artit LaoruengthanaDepartment of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Inthiporn KositanuritDepartment of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand. inthipornk@nu.ac.th.ORCID http://orcid.org/0000-0003-2413-8648
Surachart PodjanasupawunDepartment of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Chao SaenghirunvattanaDepartment of Anesthesiology, Huachiew Hospital, Bangkok, Thailand.
Krit PongpirulDepartment of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Naresuan University · THHua chiew hospital · THJohns Hopkins University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe questioned whether the triple analgesic pathways procedure via local infiltration analgesia (LIA), peripheral nerve blocks, and intrathecal morphine (ITM) is superior to LIA only for controlling pain after Total Knee Arthroplasty (TKA).

methodsThis retrospective study included 192 primary TKA patients. Group A (76 patients) received LIA only, Group B (61 patients) had ITM, adductor canal block and LIA, while Group C (55 patients) received ITM, femoral nerve block and LIA. A propensity score-matched analysis was used to compare visual analog scales (VAS) for pain intensity, total amount of morphine consumption (TMC), angle of knee flexion, and length of hospital stay (LHS).

resultsGroup A showed significantly higher VAS than Group B at 12 h (4.27 ± 2.70 vs 2.42 ± 2.35) and 18 h (4.24 ± 2.35 vs 2.18 ± 2.02), and significantly higher than Group C at 6 h (3.46 ± 3.07 vs 0.60 ± 1.50), 12 h (4.27 ± 2.70 vs 0.89 ± 1.48), and 18 h postoperative (4.24 ± 2.35 vs 1.82 ± 2.18). However, the VAS of Group C and B converged to equalize with Group A after 12 and 18 h, respectively. The TMC at 48 h postoperative of Group A was higher than that of Group B (p < 0.01). Nevertheless, there was no difference between groups in terms of knee flexion and LHS, except the LHS of Group B was longer than Group A (p = 0.04).

conclusionTriple analgesic pathways could provide a better initial analgesic profile. However, the pain seems to be rebound after resolution of nerve block and ITM, with potentially longer LHS.

Indexed as

AnalgesiaArthroplasty, Replacement, KneeAnalgesicsAnalgesics, OpioidAnesthesia, LocalAnesthetics, LocalFemoral NerveHumansMorphinePostoperative PainRetrospective StudiesAnalgesicsAnalgesics, OpioidAnesthetics, LocalMorphineAdductor canal blockFemoral nerve blockIntrathecal morphineLocal infiltration analgesiaPain controlTotal knee arthroplasty

Identifiers

PMID36260155
OpenAlexW4306766290

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.