Systematic review: According to Crowley’s systematic review, 23 studies using CONSORT 2001, (consolidated standards of reporting trials), were identified. There were deficiencies in these studies as far sample size calculation and randomization concerning under reporting of blinding. Neither regional and local anesthesia nor epidural and femoral nerve block has reduced hospital length of stay.
RCTs published after the review
Ward, James P, et al. “Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy?.” Arthroscopy 28.8 (2012):1064-1069.
shed after the Crowley article based on a small sample size of 36 subjects, concludes that based on all criteria the femoral nerve block is a good alternative to routine narcotic pain medication for hip arthroplasty.
Spangehl MJ, et al. The Chitranjan Ranawat Award: Periarticular Injections and Femoral Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial. Clin Orthop Relat Res 473.1 (2015 Jan):45-53.
160 patients undergoing knee arthoplasty received either femoral block or periarticular injection (PAI). LOS was 2.44 days for the PAI group and 2.84 days for the femoral block group.
Mahadevan D, et al. Combined femoral and sciatic nerve block vs combined femoral and periarticular infiltration in total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2012 Dec;27(10):1806-11.
Fifty-two patients undergoing total knee arthroplasty all received femoral nerve block. They were randomized to also receive either sciatic block or periarticular injection. LOS was 5.5 v. 6 days.
Evidence Matters 