Abstract
Orthopedic surgery is a broad surgical specialty with diverse procedures, regional areas of work, and pre- and postoperative pain control methods. Regional anesthesia, especially in the form of regional nerve blocks, can be completed for a vast majority of orthopedic procedures and reduce the postoperative pain and narcotic use. While these nerve blocks individually come with their own risks, they are often minimal, and the benefits of increased postoperative pain control often outweigh these risks. Intraoperatively, periarticular injections are a method of reducing postoperative pain control. The use of narcotics following orthopedic surgeries is ubiquitous, but increasing preoperative pain control counseling and education as well as the use of individualized opioid calculators have reduced postoperative narcotic prescription and increased patient awareness.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Works Cited
Phillips DM. JCAHO pain management standard are unveiled. J Am Med Assoc. 2000;284(4):428–9.
Baker D. The Joint Commission’s pain standards: origins and evolution. Oakbrook Terrace: The Joint Commission; 2017.
VHA. Pain as the 5th vital sign toolkit. Washington, DC: Veterans Health Administration; 2000.
Wyles CC, Hevesi M, Ubl DS, et al. Implementation of procedure-specific opioid guidelines. JBJS Open Access. 2020;5(1):e0050.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States, 2016. JAMA. 2016; https://doi.org/10.1001/jama.2016.1464.
Syed UAM, Aleem AW, Wowkanech C, et al. Neer award 2018: the effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial. J Shoulder Elb Surg. 2018;27(6):962–7.
Chakravarthy V, Yokoi H, Manlapaz MR, Krishnaney AA. Enhanced recovery in spine surgery and perioperative pain management. Neurosurg Clin N Am. 2020;31(1):81–91. https://doi.org/10.1016/j.nec.2019.08.010
Nir RR, Nahman-Averbuch H, Moont R, Sprecher E, Yarnitsky D. Preoperative preemptive drug administration for acute postoperative pain: a systematic review and meta-analysis. Eur J Pain (United Kingdom). 2016;20(7):1025–43.
Summers S, Mohile N, McNamara C, Osman B, Gebhard R, Hernandez VH. Analgesia in total knee arthroplasty. J Bone Joint Surg Am. 2020;102-A(8):719–27.
Il KS, Ha KY, Oh IS. Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial. Eur Spine J. 2016;25(5):1614–9.
Srikumaran U, Stein BE, Tan EW, Freehill MT, Wilckens JH, Henze EP. Upper-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection. J Bone Joint Surg Am. 2013;95(24):1–13.
Hughes M, Marava M, Wright R, Brophy R, Smith M. Interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review. J Bone Joint Surg Am. 2013;95-A(14):1318–24.
Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU. Interscalene block for shoulder arthroscopy: comparison with general anesthesia. Arthroscopy. 1993;9(3):295–300.
Garlich J, Pujari A, Debbi E, et al. Time to block: early regional anesthesia improves pain control in geriatric hip fractures. J Bone Joint Surg Am. 2020;102(10):866–72.
Stein BE, Srikumaran U, Tan EW, Freehill MT, Wilckens JH. Lower-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection. J Bone Joint Surg Am. 2012;94(22):1–13.
Borgeat A, Ekatodramis G, Schenker C. Postoperative nausea and vomiting in regional anesthesia: a review. Anesthesiology. 2003;98:530–47.
Mian A, Chaudhry I, Huang R, Rizk E, Tubbs RS, Loukas M. Brachial plexus anesthesia: a review of the relevant anatomy, complications, and anatomical variations. Clin Anat. 2014;27(2):210–21.
Jones MR, Novitch MB, Sen S, et al. Upper extremity regional anesthesia techniques: a comprehensive review for clinical anesthesiologists. Best Pract Res Clin Anaesthesiol. 2019;34(1):e13–29.
Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72(4):498–503.
Mak PHK, Irwin MG, Ooi CGC, Chow BFM. Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function. Anaesthesia. 2001;56(4):352–6.
Desroches J. The Infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients. Can J Anesth. 2003;50(3):253–7.
Chang K-V, Wu W, Hung C-Y, Han D, Yang R, Chang C. Comparative effectiveness of Suprascapular nerve block in the relief of acute post-operative shoulder pain: a systematic review and meta-analysis. Pain Physician. 2016;19:445–56.
Hussain N, Goldar G, Ragina N, Banfield L, Laffey JG, Abdallah FW. Suprascapular and Interscalene nerve block for shoulder surgery. Anesthesiology. 2017;127(6):998–1013.
Kay J, Memon M, Hu T, et al. Suprascapular nerve blockade for postoperative pain control after arthroscopic shoulder surgery: a systematic review and meta-analysis. Orthop J Sports Med. 2018;6(12):1–17.
De Leeuw MA, Zuurmond WWA, Perez RSGM. The psoas compartment block for hip surgery: the past, present, and future. Anesthesiol Res Pract. 2011;2011:1–6.
Murray JM, Derbyshire S, Shields MO. Lower limb blocks. Anaesthesia. 2010;65(Suppl 1):57–66.
Touray ST, De Leeuw MA, Zuurmond WWA, Perez RSGM. Psoas compartment block for lower extremity surgery: a meta-analysis. Br J Anaesth. 2008;101(6):750–60.
Capdevila X, Macaire P, Dadure C, et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94(6):1606–13.
Cram P, Lu X, Kaboli P, et al. Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991–2008. J Am Med Assoc. 2011;305(15):1560–7.
Biboulet P, Morau D, Aubas P, Bringuier-Branchereau S, Capdevila X. Postoperative analgesia after total-hip arthroplasty: comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. A prospective, randomized, double-blind study. Reg Anesth Pain Med. 2004;29(2):102–9.
Jeng C, Torrillo T, Rosenblatt M. Complications of peripheral nerve block. Br J Anaesth. 2010;105(51):i97–i107.
Enneking FK, Chan V, Greger J, Hadžić A, Lang SA, Horlocker TT. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med. 2005;30(1):4–35.
Wulf H, Löwe J, Gnutzmann KH, Steinfeldt T. Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstruction. Acta Anaesthesiol Scand. 2010;54(4):414–20.
Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B. Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med. 2003;28(1):29–32.
Mall NA, Wright RW. Femoral nerve block use in anterior cruciate ligament reconstruction surgery. Arthroscopy. 2010;26(3):404–16.
Hunt KJ, Bourne MH, Mariani EM. Single-injection femoral and sciatic nerve blocks for pain control after total knee arthroplasty. J Arthroplast. 2009;24(4):533–8.
Williams BA, Kentor ML, Vogt MT, et al. Femoral-sciatic nerve blocks for complex outpatient knee surgery are associated with less postoperative pain before same-day discharge: a review of 1,200 consecutive cases from the period 1996–1999. Anesthesiology. 2003;98(5):1206–13.
Zorrilla-Vaca A, Li J. The role of sciatic nerve block to complement femoral nerve block in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Anesth. 2018;32(3):341–50.
Wiegel M, Gottschaldt U, Hennebach R, Hirschberg T, Reske A. Complications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients. Anesth Analg. 2007;104(6):1578–82.
Brull R, McCartney CJL, Chan VWS, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104(4):965–74.
Kim CW, Hong JP. Lower extremity reconstruction under popliteal sciatic nerve (tibioperoneal trunk) and saphenous nerve block. Plast Reconstr Surg. 2005;115(2):563–6.
Akkaya T, Ersan O, Ozkan D, et al. Saphenous nerve block is an effective regional technique for post-meniscectomy pain. Knee Surg Sports Traumatol Arthrosc. 2008;16(9):855–8.
Grosser DM, Herr MJ, Claridge RJ, Barker LG. Preoperative lateral popliteal nerve block for intraoperative and postoperative pain control in elective foot and ankle surgery: a prospective analysis. Foot Ankle Int. 2007;28(12):1271–5.
Fraser TW, Doty JF. Peripheral nerve blocks in foot and ankle surgery. Orthop Clin North Am. 2017;48(4):507–15. https://doi.org/10.1016/j.ocl.2017.06.008.
Anderson JG, Bohay DR, Maskill JD, et al. Complications after popliteal block for foot and ankle surgery. Foot Ankle Int. 2015;36(10):1138–43.
Memtsoudis SG, Cozowicz C, Bekeris J, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the international consensus on anaesthesia-related outcomes after surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth. 2019;123(3):269–87.
Johnson RL, Abdel MP, Frank RD, Chamberlain AM, Habermann EB, Mantilla CB. Impact of frailty on outcomes after primary and revision total hip arthroplasty. J Arthroplast. 2019;34(1):56–64.e5.
Chamberlain AM, Rutten LJF, Manemann SM, et al. Frailty trajectories in an elderly population-based cohort. J Am Geriatr Soc. 2016;64(2):285–92.
McNallan SM, Chamberlain AM, Gerber Y, et al. Measuring frailty in heart failure: a community perspective. Am Heart J. 2013;166(4):768–74.
Johnson RL, Kopp SL, Burkle CM, et al. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth. 2016;116(2):163–76.
Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738–43.
Memtsoudis SG, Sun X, Chiu YL, et al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118(5):1046–58.
Olawin A, Das J. Spinal anesthesia. Treasure Island: StatPearls Publishing; 2020. p. 1–6.
Pichard CP, LaPorte DM. Use of ketorolac (toradol) in hand surgery. J Hand Surg Am. 2009;34(8):1549–50.
Kinsella J, Moffat AC, Patrick JA, Prentice JW, Mcardle CS, Kenny GNC. Ketorolac trometamol for postoperative analgesia after orthopaedic surgery. Br J Anaesth. 1992;69(1):19–22.
Mcnicol ED, Rowe E, Cooper TE. Ketorolac for postoperative pain in children. Cochrane Database Syst Rev. 2018;7(7):CD012294.
Anthony D, Jasinski DM. Postoperative pain management: morphine versus ketorolac. J Perianesth Nurs. 2002;17(1):30–42.
Kurd MF, Kreitz T, Schroeder G, Vaccaro AR. The role of multimodal analgesia in spine surgery. J Am Acad Orthop Surg. 2017;25(4):260–8.
Glassman S, Rose M, J D, Puno R, Campbell M, Johnson J. The effect of postoperative nonsteroidal anti-inflammatory drug administration on spinal Fusion. Spine (Phila Pa 1976). 1998;23:834–48.
Li Q, Zhang Z, Cai Z. High-dose ketorolac affects adult spinal fusion: a meta-analysis of the effect of perioperative nonsteroidal anti-inflammatory drugs on spinal fusion. Spine (Phila Pa 1976). 2011;36(7):461–8.
Huang PS, Gleason SM, Shah JA, Buros AF, Hoffman DA. Efficacy of intravenous acetaminophen for postoperative analgesia in primary Total knee Arthroplasty. J Arthroplast. 2018;33(4):1052–6.
Greenky MR, McGrath ME, Levicoff EA, et al. Intraoperative surgeon administered Adductor Canal blockade is not inferior to anesthesiologist administered Adductor Canal blockade: a prospective randomized trial. J Arthroplast. 2020;35(5):1228–32.
Tammachote N, Kanitnate S, Manuwong S, Panichkul P. Periarticular multimodal drug injection is better than single anesthetic drug in controlling pain after total knee arthroplasty. Eur J Orthop Surg Traumatol. 2018;28(4):667–75.
Koehler D, Marsh JL, Karam M, Fruehling C, Willey M. Efficacy of surgical-site, multimodal drug injection following operative management of femoral fractures: a randomized controlled trial. J Bone Joint Surg Am. 2017;99(6):512–9.
Milani P, Castelli P, Sola M, Invernizzi M, Massazza G, Cisari C. Multimodal analgesia in total knee arthroplasty: a randomized, double-blind, controlled trial on additional efficacy of periarticular anesthesia. J Arthroplast. 2015;30(11):2038–42.
Shrank WH. Our bulging medicine cabinets – the other side of medication nonadherence. N Engl J Med. 2011;364(17):1591–3.
Rodgers J, Cunningham K, Fitzgerald K, Finnerty E. Opioid consumption following outpatient upper extremity surgery. J Hand Surg Am. 2012;37(4):645–50.
Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol. 2011;185(2):551–5.
Kim N, Matzon JL, Abboudi J, et al. A prospective evaluation of opioid utilization after upper-extremity surgical procedures: identifying consumption patterns and determining prescribing guidelines. J Bone Joint Surg Am. 2016;98-A(20):1–9.
Jamieson MD, Everhart JS, Lin JS, Jain SA, Awan HM, Goyal KS. Reduction of opioid use after upper-extremity surgery through a predictive pain calculator and comprehensive pain plan. J Hand Surg Am. 2019;44(12):1050–1059.e4.
Disclosures
No financial disclosures or conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hanley, J., LoGiudice, A. (2021). Perioperative Analgesia for Orthopedic Surgery. In: Svider, P.F., Pashkova, A.A., Johnson, A.P. (eds) Perioperative Pain Control: Tools for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-56081-2_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-56081-2_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-56080-5
Online ISBN: 978-3-030-56081-2
eBook Packages: MedicineMedicine (R0)