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Regional and Multimodal Analgesia to Reduce Opioid Use After Total Joint Arthroplasty: A Narrative Review

  • Ellen M. Soffin
  • Christopher L. Wu
OPIOID PRESCRIBING AND PAIN MANAGEMENT / REVIEW ARTICLE

Abstract

Background

Elective total joint arthroplasty may be a gateway to long-term opioid use.

Questions/Purpose

We sought to review the literature on multimodal and regional analgesia as a strategy to minimize perioperative opioid use and control pain in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods

We conducted a narrative review to assess the state of the evidence informing opioid-sparing analgesics for THA and TKA. A PubMed search was conducted for English-language articles published before April 2018. We preferentially included well-designed randomized controlled trials, systematic reviews, and meta-analyses. Where the highest levels of evidence were not yet apparent, we evaluated retrospective and/or observational studies.

Results

Multimodal analgesia emphasizing nonsteroidal anti-inflammatory agents and acetaminophen is associated with decreases in perioperative opioid use for THA and TKA. Regional analgesia, including peripheral nerve blocks and local infiltration analgesia, is also associated with decreased perioperative opioid use for THA and TKA. Emerging topics in post-arthroplasty analgesia include (1) the value of nonsteroidal anti-inflammatory drugs, (2) the use of peripheral nerve catheters and extended-release local anesthetics to prolong the duration of opioid-free analgesia, and (3) novel peripheral nerve blocks, exemplified by the IPACK (interspace between the popliteal artery and posterior capsule of the knee) block for TKA.

Conclusions

The use of multimodal analgesia with regional techniques may decrease perioperative opioid use for patients undergoing THA and TKA. These techniques should be part of a comprehensive perioperative plan to promote adequate analgesia while minimizing overall opioid exposure.

Keywords

opioid crisis orthopedic surgery total joint arthroplasty multimodal analgesia regional analgesia peripheral nerve block 

Notes

Compliance with Ethical Standards

Conflict of Interest

Ellen M. Soffin, MD, PhD, and Christopher L. Wu, MD, declare that they have no conflicts of interest.

Human/Animal Rights

N/A

Informed Consent

N/A

Required Author Forms:

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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ESM 1 (PDF 1224 kb)
11420_2018_9652_MOESM2_ESM.pdf (1.2 mb)
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Copyright information

© Hospital for Special Surgery 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Critical Care and Pain ManagementHospital for Special SurgeryNew YorkUSA
  2. 2.Department of AnesthesiologyWeill Cornell Medical College and New York Presbyterian HospitalNew YorkUSA
  3. 3.Armstrong Institute for Patient Safety and QualityJohns Hopkins UniversityBaltimoreUSA

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