TY - JOUR T1 - Intra-articular infiltration analgesia for arthroscopic shoulder surgery: a systematic review and meta-analysis. AU - Yung,E M, AU - Got,T C, AU - Patel,N, AU - Brull,R, AU - Abdallah,F W, Y1 - 2020/06/29/ PY - 2020/06/03/accepted PY - 2020/7/1/pubmed PY - 2021/3/26/medline PY - 2020/6/30/entrez KW - Intra-articular infiltration analgesia KW - Laparoscopic surgery KW - arthroscopic shoulder surgery KW - interscalene block KW - postoperative pain control SP - 549 EP - 558 JF - Anaesthesia JO - Anaesthesia VL - 76 IS - 4 N2 - Phrenic-sparing analgesic techniques for shoulder surgery are desirable. Intra-articular infiltration analgesia is one promising phrenic-sparing modality, but its role remains unclear because of conflicting evidence of analgesic efficacy and theoretical concerns regarding chondrotoxicity. This systematic review and meta-analysis evaluated the benefits and risks of intra-articular infiltration in arthroscopic shoulder surgery compared with systemic analgesia or interscalene brachial plexus block. We sought randomised controlled trials comparing intra-articular infiltration with interscalene brachial plexus block or systemic analgesia (control). Cumulative 24-h postoperative oral morphine equivalent consumption was designated as the primary outcome. Secondary outcomes included visual analogue scale pain scores during the first 24 h postoperatively; time-to-first analgesic request; patient satisfaction; opioid-related side-effects; block-related adverse events; and any indicators of chondrotoxicity. Fifteen trials (863 patients) were included. Compared with control, intra-articular infiltration reduced 24-h postoperative analgesic consumption by a weighted mean difference (95%CI) of -30.9 ([-38.9 to -22.9]; p < 0.001). Intra-articular infiltration also reduced the weighted mean difference (95%CI) pain scores up to 12 h postoperatively, with the greatest reduction at 4 h (-2.2 cm [(-4.4 to -0.04]); p < 0.05). Compared with interscalene brachial plexus block, there was no difference in opioid consumption, but patients receiving interscalene brachial plexus block had better pain scores at 2, 4 and 24 h postoperatively. There was no difference in opioid- or block-related adverse events, and none of the trials reported chondrotoxic effects. Compared with systemic analgesia, intra-articular infiltration provides superior pain control, reduces opioid consumption and enhances patient satisfaction, but it may be inferior to interscalene brachial plexus block patients having arthroscopic shoulder surgery. SN - 1365-2044 UR - https://www.unboundmedicine.com/medline/citation/32596840/Intra_articular_infiltration_analgesia_for_arthroscopic_shoulder_surgery:_a_systematic_review_and_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -