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Multimodal Pain Management Strategies in Total Joint Arthroplasty

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Rapid Recovery in Total Joint Arthroplasty

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Abstract

While the dramatic shift in the perioperative management of patients undergoing same-day total joint arthroplasty has played a substantial role in the increasing frequency of these procedures today, adequate pain management remains paramount to rapid recovery protocols. Effective multimodal pain regimens should enable patients to “get ahead and stay ahead” of pain throughout all phases of the perioperative period. Preoperatively, this involves the administration of medications aimed at reducing nerve fiber sensitization and limiting the inflammatory response. The method of anesthesia employed intraoperatively should provide reliable sensory and motor blockade for the duration of the procedure, but its effects should not persist after completion of surgery so as not to impede rapid recovery. Adjunctive analgesic modalities such as peripheral nerve blocks and periarticular injections should be utilized liberally, but in a manner that provides effective pain relief without compromising early ambulation. Postoperatively, opioids should be used sparingly, and the number of narcotics prescribed to patients at discharge should be limited and in accordance with local state laws. The employment of comprehensive multimodal pain regimens in same-day total joint arthroplasty can successfully facilitate same-day discharges without compromising patient safety or satisfaction.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Benjamin M. Wooster & Mark W. Pagnano

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  1. Benjamin M. Wooster
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  2. Mark W. Pagnano
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Correspondence to Mark W. Pagnano .

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Editors and Affiliations

  1. Northwell Orthopedic Institute, New York, NY, USA

    Giles R. Scuderi

  2. The Orthopaedic Center of New Jersey, Somerset, NJ, USA

    Alfred J. Tria

  3. Hospital for Special Surgery, New York, NY, USA

    Fred D. Cushner

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Wooster, B.M., Pagnano, M.W. (2020). Multimodal Pain Management Strategies in Total Joint Arthroplasty. In: Scuderi, G., Tria, A., Cushner, F. (eds) Rapid Recovery in Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-41223-4_15

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  • DOI: https://doi.org/10.1007/978-3-030-41223-4_15

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