EFEITO DO BLOQUEIO PERIARTICULAR ADJUVANTE EM COMPARAÇÃO À ANESTESIA ESPINHAL ISOLADA EM ARTROPLASTIA TOTAL DO JOELHO: REVISÃO SISTEMÁTICA COM METANÁLISE

• DOI: https://doi.org/10.22533/at.ed.6691725210810

• Palavras-chave: artroplastia do joelho; anestesia espinhal; bloqueio periarticular; analgesia multimodal; metanálise.

• Keywords: knee arthroplasty; spinal anesthesia; periarticular block; multimodal analgesia; meta-analysis.

• Abstract: Total knee arthroplasty (TKA) is associated with significant postoperative pain, and multimodal periarticular block (MMB) has been proposed as an adjunct to spinal anesthesia (SA) to improve analgesic control. To evaluate the efficacy of MMB as an adjunct to SA compared with SA alone in reducing pain, opioid consumption, and adverse events after elective TKA. A systematic review with meta-analysis conducted in accordance with PRISMA. Randomized controlled trials (RCTs) comparing MMB + SA versus SA alone in adults undergoing TKA were included. Searches were performed in PubMed and EMBASE up to June 2025. Two independent reviewers conducted screening, data extraction, and risk of bias assessment (RoB 2.0). Outcomes included pain (VAS), opioid consumption (morphine milligram equivalents), and adverse events (nausea, vomiting, motor block). Analyses were performed in RevMan Web using the DerSimonian-Laird random-effects model, with mean difference (MD) and risk ratio (RR), both with 95% CI. Heterogeneity was assessed using the I² index. Five RCTs were included (n = 603). The MMB group showed lower pain (MD -0.83 [95% CI -1.18 to -0.48]; p < 0.001), reduced opioid consumption (MD -7.52 mg [95% CI -11.43 to -3.61]; p < 0.001), and lower incidence of adverse events (RR 0.61 [95% CI 0.41 to 0.91]; p = 0.015). MMB as an adjunct to SA reduces pain, opioid consumption, and adverse events in the immediate postoperative period of TKA.