In recent years, there has been an increasing interest in local infiltration
analgesia (LIA) as a technique to control
postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for
total knee arthroplasty (TKA) and
total hip arthroplasty (THA) to evaluate the
analgesic efficacy of LIA for early
postoperative pain treatment. In addition, the
analgesic efficacy of
wound catheters and implications for length of
hospital stay (LOS) were evaluated. Twenty-seven randomized controlled trials in 756 patients operated on with THA and 888 patients operated on with TKA were selected for inclusion in the review. In THA, no additional
analgesic effect of LIA compared with placebo was reported in trials with low risk of bias when a multimodal
analgesic regimen was administered perioperatively. Compared with intrathecal
morphine and
epidural analgesia, LIA was reported to have similar or improved
analgesic efficacy. In TKA, most trials reported reduced
pain and reduced
opioid requirements with LIA compared with a control group treated with placebo/no injection. Compared with femoral nerve block, epidural or intrathecal
morphine LIA provided similar or improved
analgesia in the early postoperative period but most trials had a high risk of bias due to different systemic
analgesia between groups. Overall, the use of
wound catheters for postoperative administration of local anaesthetic was not supported in the included trials, and LOS was not related to
analgesic efficacy. Despite the many studies of LIA, final interpretation is hindered by methodological insufficiencies in most studies, especially because of differences in use of systemic
analgesia between groups. However, LIA provides effective
analgesia in the initial postoperative period after TKA in most randomized clinical trials even when combined with multimodal systemic
analgesia. In contrast, LIA may have limited additional
analgesic efficacy in THA when combined with a multimodal
analgesic regimen. Postoperative administration of local anaesthetic in
wound catheters did not provide additional
analgesia when systemic
analgesia was similar and LOS was not related to use of LIA with a fast-track set-up.