Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

  • Aditya V. Maheshwari
  • Yossef C. Blum
  • Laghvendu Shekhar
  • Amar S. Ranawat
  • Chitranjan S. Ranawat
Symposium: Advanced Techniques for Rehabilitation after Total Hip and Knee Arthroplasty


Improvements in pain management techniques in the last decade have had a major impact on the practice of total hip and knee arthroplasty (THA and TKA). Although there are a number of treatment options for postoperative pain, a gold standard has not been established. However, there appears to be a shift towards multimodal approaches using regional anesthesia to minimize narcotic consumption and to avoid narcotic-related side effects. Over the last 10 years, we have used intravenous patient-controlled analgesia (PCA), femoral nerve block (FNB), and continuous epidural infusions for 24 and 48 hours with and without FNB. Unfortunately, all of these techniques had shortcomings, not the least of which was suboptimal pain control and unwanted side effects. Our practice has currently evolved to using a multimodal protocol that emphasizes local periarticular injections while minimizing the use of parenteral narcotics. Multimodal protocols after THA and TKA have been a substantial advance; they provide better pain control and patient satisfaction, lower overall narcotic consumption, reduce hospital stay, and improve function while minimizing complications. Although no pain protocol is ideal, it is clear that patients should have optimum pain control after TKA and THA for enhanced satisfaction and function.

Level of Evidence: Level V, expert opinion. See the Guidelines for Authors for a complete description of levels of evidence.


Epidural Analgesia Epidural Infusion Femoral Nerve Block Toradol Preemptive Analgesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© The Association of Bone and Joint Surgeons 2009

Authors and Affiliations

  • Aditya V. Maheshwari
    • 1
  • Yossef C. Blum
    • 1
  • Laghvendu Shekhar
    • 1
  • Amar S. Ranawat
    • 1
  • Chitranjan S. Ranawat
    • 1
  1. 1.Hospital for Special SurgeryNew York USA

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