Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center
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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.
KeywordsEpidural Analgesia Epidural Infusion Femoral Nerve Block Toradol Preemptive Analgesia
- 14.International Association for the Study of Pain (IASP) Task Force on Taxonomy Part III. Pain Terms. A Current List with Definitions and Notes on Usage. In: Merskey H, Bogduk N, eds. Classification of Chronic Pain, 2nd ed. Seattle, WA: IASP Press; 1994:209–214. [Available at http://www.iasp-pain.org. Accessed June 23, 2008].
- 15.Joint Commission on Accreditation of Healthcare Organizations. Pain Standards for 2001. Oakbook Terrace, IL: JCAHO; 2000.Google Scholar
- 21.Morin AM, Kratz CD, Eberhart LH, Dinges G, Heider E, Schwarz N, Eisenhardt G, Geldner G, Wulf H. Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block. Reg Anesth Pain Med. 2005;30:434–445.PubMedGoogle Scholar
- 30.Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87:88–92.PubMedCrossRefGoogle Scholar
- 31.Singelyn FJ, Ferrant T, Malisse MF, Joris D. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Reg Anesth Pain Med. 2005;30:452–457.PubMedGoogle Scholar