The analgetic effect of adjuvants in local infiltration analgesia - a systematic review with network meta-analysis of randomized trials
Authors' conclusion
There is moderate evidence that dexamethasone is the most effective adjuvant to prolong the duration of analgesia in LIA.
Study context
- Population
- Patients receiving local infiltration analgesia (LIA) (intra-/peri-articular or wound infiltration) for postoperative pain
- Comparison
- Adjuvants added to local anaesthetic in local infiltration analgesia
- Outcome
- Duration of analgesia
Methodological detailsprespecified subgroup analysis (knee LIA), Embase, CENTRAL, MEDLINE and Web of Science searched up to March 2023
- Prespecified subgroup analysis (knee LIA)
- Embase, CENTRAL, MEDLINE and Web of Science searched up to March 2023
Pooled result
As reported in the abstract
Duration of analgesia (ratio of means)
| Group | Ratio of Means (ROM) |
|---|---|
| Dexamethasone | 3.33 |
| Clonidine + morphine | 3.35 |
| Morphine + magnesium sulfate | 2.92 |
| Fentanyl | 2.27 |
| Ketorolac | 2.26 |
| Buprenorphine | 2.04 |
| Morphine | 1.93 |
| Magnesium sulfate | 1.91 |
| Clonidine | 1.89 |
| Dexmedetomidine | 1.74 |
| Tramadol | 1.58 |
Ratio of Means (ROM)
Dexamethasone3.33
Clonidine + morphine3.35
Morphine + magnesium sulfate2.92
Fentanyl2.27
Ketorolac2.26
Buprenorphine2.04
Morphine1.93
Magnesium sulfate1.91
Clonidine1.89
Dexmedetomidine1.74
Tramadol1.58
Further pooled results
Pain scores and morphine-equivalent (MEQ) consumption
- Clonidine and dexmedetomidine: small effect on pain scores, below clinical relevance, but largest effect on MEQ consumption
- Effects of different opioids homogenous for all endpoints
Knee LIA (prespecified subgroup)
- Not significantly different from pooled analysis
Safety
Serious adverse events
- Not reported with any investigated adjuvant
Original publication
The analgetic effect of adjuvants in local infiltration analgesia - a systematic review with network meta-analysis of randomized trials. J Clin Anesth. Published 13 July 2024. doi:10.
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