Intraoperative Periarticular Injection and Postoperative Pain/Opioid Use in TJA

We reviewed thirty-four studies that evaluated the effectiveness of intraoperative periarticular injection on reducing postoperative pain and/or opioid consumption after primary TJA.[2–35] Thirty studies were high quality, and four were moderate quality.[2–35] Due to heterogeneity in the outcomes reported, and the timepoints at which the outcomes were reported, a limited number of direct meta-analyses were performed.

All studies, except for one, evaluated the effectiveness of periarticular injection on postoperative pain after primary TJA.[2–16,18–35] Periarticular injection consistently reduced postoperative pain after primary TJA compared to control. Among the thirty-three studies, twenty studies found that periarticular injection reduced postoperative pain after primary TJA compared to control. [2–4,6–13,16,17,19,20,23,26,31,33,35] Five studies included in a direct meta-analysis with limited heterogeneity (I2 = 30.4%) found that patients who received periarticular injection reported reduced pain with activity at 24 hours postoperatively (-0.53 standardized mean difference [SMD]; 95% confidence interval [CI] -0.80 to -0.25). [3,5,8,19,35] 

Twenty-five studies evaluated the effectiveness of periarticular injection on postoperative opioid consumption after primary TJA. [2–5,7,9,11,12,14–24,26,28,30–32,35] Only a qualitative analysis was performed due to the different timepoints at which opioid consumption was reported postoperatively. Similar to postoperative pain, periarticular injection  consistently reduced postoperative opioid consumption after primary TJA. Seventeen studies reported reduced opioid consumption with periarticular injection administered during primary TJA.[2–5,9,11,14,16–19,24,26,30–32,35] The remaining eight studies found no difference in postoperative opioid consumption between periarticular injection and control. [7,12,15,20–23,28]