Skip to main content
SpringerLink
Log in

Multimodal Analgesia

  • Reference work entry
  • First Online:
Minimally Invasive Surgery in Orthopedics

Abstract

Effective pain control is essential in modern healthcare and is particularly important in orthopedics. Unfortunately, a perfect technique for pain management has yet to be developed. Currently, the use of local anesthetics together with adjunctive agents and, if necessary, opiates in moderation - a technique known as ‘multimodal analgesia’ - is thought to represent the best approach to surgical pain. This chapter will consider the various non-opioid analgesic adjuvants used in clinical practice today.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 899.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27:759–69.

    Article  Google Scholar 

  2. Ibrahim MS, Alazzawi S, Nizam I, Haddad FS. An evidence-based review of enhanced recovery interventions in knee replacement surgery. Ann R Coll Surg Engl. 2013;95:386–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Gerbershagen HJ, Aduckathil S, van Wijck AJM, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery. A prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118:934–44.

    Article  PubMed  Google Scholar 

  4. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77:1048–56.

    Article  CAS  PubMed  Google Scholar 

  5. Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014;29:329–34.

    Article  PubMed  Google Scholar 

  6. Duncan CM, Moeschler SM, Horlocker TT, Hanssen AD, Hebl JR. A self-paired comparison of perioperative outcomes before and after implementation of a clinical pathway in patients undergoing total knee arthroplasty. Reg Anesth Pain Med. 2013;38:533–8.

    Article  PubMed  Google Scholar 

  7. De Oliveira GS, Agarwal D, Benzon HT. Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials. Anesth Analg. 2012;114:424–33.

    Article  PubMed  Google Scholar 

  8. Coxib and traditional NSAID Trialists’ (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382:769–79.

    Article  Google Scholar 

  9. Kurmis AP, Kurmis TP, O’Brien JX, Dalen T. The effect of non-steroidal anti-inflammatory drug administration on acute phase fracture-healing: a review. J Bone Joint Surg Am. 2012;94:815–23.

    Article  PubMed  Google Scholar 

  10. Maund E, McDaid C, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. Br J Anaesth. 2011;106:292–7.

    Article  CAS  PubMed  Google Scholar 

  11. Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110:1170–9.

    CAS  PubMed  Google Scholar 

  12. Chang CY, Challa CK, Shah J, Eloy JD. Gabapentin in acute postoperative pain management. Biomed Res Int. 2014; Article ID 631756, 7 p.

    Google Scholar 

  13. Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg. 2012;115:428–42.

    Article  CAS  PubMed  Google Scholar 

  14. Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006;1:CD004603.

    PubMed  Google Scholar 

  15. Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev. 2013;7:CD008307.

    PubMed  Google Scholar 

  16. Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity. Systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116:1312–22.

    Article  CAS  PubMed  Google Scholar 

  17. Chan AKM, Cheung CW, Chong YK. Alpha-2 agonists in acute pain management. Expert Opin Pharmacother. 2010;11:2849–68.

    Article  CAS  PubMed  Google Scholar 

  18. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. 2013;110:191–200.

    Article  CAS  PubMed  Google Scholar 

  19. Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin N Am. 2015;95:301–18.

    Article  PubMed  Google Scholar 

  20. American Society of Anesthesiologists Task Force on Acute Pain management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116:248–73.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Billings Clinic Hospital, Billings, MT, USA

    Brian Harrington

  2. Department Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Thomas Halaszynski

  3. North Shore Health System, Valley Stream, NY, USA

    Joseph Marino

Authors
  1. Brian Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Halaszynski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph Marino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian Harrington .

Editor information

Editors and Affiliations

  1. Orthopedic Service Line, Northwell Health , New York, New York, USA

    Giles R. Scuderi

  2. Department of Orthopedic Surgery, Rutgers-Robert Wood JohnsonMedicalSchool Department of Orthopedic Surgery, New Brunswick, New Jersey, USA

    Alfred J. Tria

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this entry

Cite this entry

Harrington, B., Halaszynski, T., Marino, J. (2016). Multimodal Analgesia. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. https://doi.org/10.1007/978-3-319-34109-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-34109-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-34107-1

  • Online ISBN: 978-3-319-34109-5

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation