Current Concepts Review Analgesia in Total Knee Arthroplasty Current Pain Control Modalities and Outcomes (original) (raw)
Related papers
Analgesia in Total Knee Arthroplasty
Journal of Bone and Joint Surgery, 2020
➢ Implementation of multimodal pain management regimens after total knee arthroplasty has increased patient satisfaction, decreased pain scores, and facilitated faster recovery.➢ A variety of oral and intravenous analgesics, including nonsteroidal anti-inflammatory drugs, gabapentinoids, acetaminophen, and opioids, can be employed preoperatively and postoperatively.➢ Neuraxial anesthesia, peripheral nerve blocks, and periarticular injections are effective pain modulators that should be implemented in concert with the anesthesia teams.➢ There is no consensus on the optimal multimodal pain regimen, and substantial variability exists between institutions and providers.➢ The goals of minimizing pain and improving functional recovery in the postoperative period must be considered in light of evidence-based practice as well as the risk profile of the proposed analgesic treatment.
A Multimodal Analgesia Protocol for Total Knee Arthroplasty
The Journal of Bone and Joint Surgery (American), 2006
Background: Although numerous methods of postoperative analgesia have been investigated in an attempt to improve pain control after total knee arthroplasty, parenteral narcotics still play a major role in postoperative pain management. Local anesthetics have the advantage of blocking pain conduction at its origin and minimizing the systemic side effects associated with postoperative narcotic use. This study was performed to evaluate the benefits and safety of a multimodal analgesia protocol that included periarticular injection of large doses of local anesthetics in patients undergoing total knee arthroplasty.
Postoperative Analgesia in Total Knee Arthroplasty (TKA)- The Changing Trends
BJSTR, 2017
Joint replacement surgeries are considered as one of the most painful procedure in orthopedics. Achieving complete and long term pain relief starts from the time of surgery, and perhaps even before the surgery. The traditional approached involved high dose opioid based regimen, though opioid are considered strong analgesic, but are associated with number of unwanted side effects which lead the researcher to sought for alternative techniques. Neuraxial techniques (intrathecal long acting opioid) and continuous epidural analgesia were popular and were accepted by many but they also have limitations and drawback, after epidural analgesia, next popular technique that has evolve major nerve block namely femoral and sciatic, of which femoral nerve block (FNB) seems to provide equianalgesia to epidural without the side effects of epidural. The role of sciatic nerve block in TKA pain is doubtful. FNB still hold its place and many expert consider femoral nerve block as gold standard, however, FNB is associated with quadriceps weakness and risk of fall and sciatic block with foot drop. To overcome these drawback- more distal nerve block techniques has evolved- namely saphenous nerve block in adductor canal, selective tibial which are claimed to provide comparable analgesia to that of femoral and sciatic nerve block. The combination of pre-emptive and multi-modal analgesia and technically well delivered regional nerve blocks and postoperative physical therapy are essential component which not only minimize the side effects of traditional opioid based analgesia but also speed up functional recovery, increases patient satisfaction and reduces overall length of hospitalisation and cost.
Multimodal Analgesia Without Parenteral Narcotics for Total Knee Arthroplasty
The Journal of Arthroplasty, 2008
Use of parenteral narcotics after total knee arthroplasty is considered by most orthopedic surgeons to be the standard of care. This study tested the hypothesis that a multimodal oral pain medication protocol could control pain and minimize complications of parenteral narcotics. Postoperative oral analgesia was augmented with either continuous epidural infusion or continuous femoral infusion using ropivacaine only. Seventy patients had total knee arthroplasty with a protocol that included preemptive oral analgesics, epidural anesthesia, pericapsular analgesic injection, and postoperative analgesia without parenteral opioids. The average daily pain score was less than 4 out of 10, nausea occurred in 15 patients (21%), emesis in 1 patient (1.4%), and there were no severe complications. This study proved the hypothesis that pain after total knee arthroplasty could be effectively managed without routine use of parenteral opioids.
Evaluation of analgesic regimens in total knee artroplasty, retrospective study
Northern Clinics of Istanbul, 2017
OBJECTIVE: Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA). METHODS: The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated. In all, 63 patients met the inclusion criteria. Hemodynamic records and Visual Analogue Scale (VAS) pain scores for postoperative 0, 2, 4, 6, 9, and 12 hours were evaluated and patients were separated into 3 groups. Group 1: FNB with 0.25% bupivacaine, Group 2: FNB with 0.166% bupivacaine, and Group 3: No FNB. RESULTS: The average age of the patients was 64.3±14.9 years and average body mass index (BMI) was 32.5±5.3 kg/m 2. There was no statistical difference between groups in age, gender, American Society of Anesthesiologists (ASA) classification of physical health scores, BMI, or anesthesia type (p<0.05). When VAS scores at postoperative time intervals were compared, there was a statistically significant difference between Group 1 and Group 2 (p>0.05). When difference between Groups 1 and 3 and Groups 2 and 3 were compared, the difference was statistically significant for VAS 0 (p>0.05). Additional analgesic use was highest in Group 3. CONCLUSION: This study demonstrated that FNB significantly decreases postoperative pain intensity and additional analgesia requirement in patients undergoing TKA. A concentration of 0.166% bupivacaine is as effective as a concentration of 0.25% when used as part of a multimodal analgesia regimen in TKA.
Update on Post-Operative Analgesia in Total Knee Replacement
jasc, 2019
Achieving optimal pain control following TKA remains a challenge, given its subjective nature and patient variability. As a result, it is difficult to devise a "one fits all" analgesic regimen. In this analysis, were viewed the use and efficacy of different modes of perioperative analgesia. The purpose of this review is to present the new protocols and classic strategies for the management of pain in the post-operated patient of total knee replacement as well as the multimodal analgesia regimen which has been widely used in recent years.
Medical Science Monitor, 2017
Departmental sources Background: We compared the effects of continuous femoral nerve block (CFNB) and continuous intraarticular block (CIAB) on pain, functional recovery and adverse effects after total knee arthroplasty (TKA). Material/Methods: We prospectively randomized 54 patients undergoing TKA into 2 groups: CFNB (Group F) and CIAB (Group I). Surgery was performed under spinal anesthesia. All patients received patient-controlled analgesia (PCA) with morphine, diclofenac, and acetaminophen for the first 72 h postoperatively. Pain was assessed with a visual analog scale (VAS), 48-h morphine consumption and 72-h local anesthetic dosage were recorded, motor blockade was assessed, maximum range of motion (ROM) was measured, and adverse effect profiles were recorded. Results: There was no significant difference in postoperative pain at rest, in passive motion, active motion, or active movement (2-min walk test (2MWT)) between study groups. Group I had less opioid usage in the first 24 h postoperatively (p<0.05). No significant difference was found between the groups in the postoperative local anesthetic dosage (p>0.05). Significantly lower scores of Bromage scale in Group I in 72 h after surgery (p<0.05) were found. Group I had superior passive maximum ROM in 1 month after surgery and superior active maximum ROM on day 7 and at 1 month after surgery (p<0.05). Conclusions: Both CFNB and CIAB are effective postoperative analgesia methods after TKA. CIAB leads to lower postoperative opioid usage in the first 24 h, lower motor blockade in the first 72 h, and better knee function on day 7 and at 1 month after surgery.
Anesthesiology
BackgroundAn optimal opioid-sparing multimodal analgesic regimen to treat severe pain can enhance recovery after total knee arthroplasty. The hypothesis was that adding five recently described intravenous and regional interventions to multimodal analgesic regimen can further reduce opioid consumption.MethodsIn a double-blinded fashion, 78 patients undergoing elective total knee arthroplasty were randomized to either (1) a control group (n = 39) that received spinal anesthesia with intrathecal morphine, periarticular local anesthesia infiltration, intravenous dexamethasone, and a single injection adductor canal block or (2) a study group (n = 39) that received the same set of analgesic treatments plus five additional interventions: local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, intraoperative intravenous dexmedetomidine and ketamine, and postoperatively, one additional intravenous dexamethasone bolus and two additional adductor canal blo...