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Opioid-Free Total Knee Arthroplasty? Local Infiltration Analgesia Plus Multimodal Blood-Loss Prevention Make it Possible

  • OPIOID PRESCRIBING AND PAIN MANAGEMENT / COMMENTARY
  • Published:
HSS Journal ®

A Correction to this article was published on 01 April 2019

This article has been updated

Abstract

Opioids have been widely used in the USA for pain control after total knee arthroplasty (TKA). However, adverse effects, especially the possibility of addiction, have increased interest in opioid-free pain management after surgery. We therefore sought to review current pain management protocols after TKA, focusing especially on opioid-free alternatives. We reviewed the literature on pain management after TKA using Medline (PubMed), through June 30, 2018, using the keywords “TKA” and “analgesia.” We found 388 articles but chose to analyze the 34 that presented high-quality (levels I and II) evidence. Local infiltration analgesia (LIA) is a good option for reducing the use of post-operative opioids; many reports have compared LIA against a nerve block or studied the synergies between two protocols of loco-regional anesthesia. Multimodal blood-loss prevention is sometimes recommended in combination with opioid-free analgesia. In most studies, however, no differences are reported or contradictory results exist. Post-operative pain management protocols vary so much that it is difficult to strongly favor a determined pathway.

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Change history

  • 01 April 2019

    Due to a metadata tagging error, the name of author E. Carlos Rodriguez-Merchan was indexed incorrectly. E. Carlos is the given name and Rodriguez-Merchan is the family name.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Knee Surgery Unit, La Paz University Hospital—IdiPaz, Paseo de la Castellana 261, 28046, Madrid, Spain

    E. Carlos Rodriguez-Merchan MD, PhD, Alfonso Vaquero-Picado MD, FEBOT & Juan S. Ruiz-Perez MD

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  1. E. Carlos Rodriguez-Merchan MD, PhD
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  2. Alfonso Vaquero-Picado MD, FEBOT
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  3. Juan S. Ruiz-Perez MD
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Corresponding author

Correspondence to E. Carlos Rodriguez-Merchan MD, PhD.

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Conflict of Interest: E. Carlos Rodriguez-Merchan, MD, PhD, Alfonso Vaquero-Picado, MD, FEBOT, and Juan S. Ruiz-Perez, MD, declare that they have no conflicts of interest.

Human/Animal Rights: N/A

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Carlos Rodriguez-Merchan, E., Vaquero-Picado, A. & Ruiz-Perez, J.S. Opioid-Free Total Knee Arthroplasty? Local Infiltration Analgesia Plus Multimodal Blood-Loss Prevention Make it Possible. HSS Jrnl 15, 17–19 (2019). https://doi.org/10.1007/s11420-018-9636-2

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  • DOI: https://doi.org/10.1007/s11420-018-9636-2

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