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.
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No funding was received for this manuscript. However, the research foundation of one or more of the authors (ASR, CSR) has received funding from DePuy Orthopaedics (Warsaw, IN) and Stryker Orthopaedics (Mahwah, NJ). One or more of the authors (ASR, CSR) has received royalties from DePuy Orthopaedics (Warsaw, IN) and Stryker Orthopaedics (Mahwah, NJ). ASR is a consultant for DePuy Orthopaedics (Warsaw, IN) and Stryker Orthopaedics (Mahwah, NJ). CSR is designer/consultant for DePuy Orthopaedics (Warsaw, IN) and Stryker Orthopaedics (Mahwah, NJ).
Each author certifies that his institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Maheshwari, A.V., Blum, Y.C., Shekhar, L. et al. Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467, 1418 (2009). https://doi.org/10.1007/s11999-009-0728-7
- Epidural Analgesia
- Epidural Infusion
- Femoral Nerve Block
- Preemptive Analgesia