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Dealing with Pain Using a “Fast-Track” (Multimodal) Protocol: The Experience from the United States

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Perioperative Medical Management for Total Joint Arthroplasty

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Abstract

The multimodal approach to postoperative pain control has become an important component of the perioperative fast-track management of patients undergoing joint replacement surgery. Multimodal pain management aims to combine different adjunctive methods that act at different steps in the pain pathway in an attempt to achieve effective pain control with fewer adverse effects. Studies have suggested several benefits to using a multimodal regimen including decreased use of opioids and adverse effects. The goal of this chapter is to provide an overview of the multimodal approach to pain management, discuss its different components and corresponding literature, and describe how the approach is implemented in our institution.

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References

  • Abdallah FW, Brull R (2011) Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review. Reg Anesth Pain Med 36(5):493–498

    PubMed  Google Scholar 

  • Abramson DI et al (1966) Effect of tissue temperatures and blood flow on motor nerve conduction velocity. JAMA 198(10):1082–1088

    CAS  PubMed  Google Scholar 

  • Adam F et al (2005) Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty. Anesth Analg 100(2):475–480

    CAS  PubMed Central  PubMed  Google Scholar 

  • Adie S et al (2012) Cryotherapy following total knee replacement. Cochrane Database Syst Rev (9):CD007911

    Google Scholar 

  • Affas F et al (2011) Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop 82(4):441–447

    PubMed Central  PubMed  Google Scholar 

  • American Society of Anesthesiologists Task Force on Acute Pain Management (2012) Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116(2):248–273

    Google Scholar 

  • Andersen KV et al (2010) A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 81(5):606–610

    PubMed Central  PubMed  Google Scholar 

  • Anon, Drugs@FDA: FDA Approved Drug Products. Available at: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm/fuseaction=Search. Accessed 30 Dec 2013

  • Apfelbaum JL et al (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97(2):534–540, table of contents

    PubMed  Google Scholar 

  • Aveline C et al (2009) Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam. Eur J Pain (London, England) 13(6):613–619

    CAS  Google Scholar 

  • Awad IT, Duggan EM (2005) Posterior lumbar plexus block: anatomy, approaches, and techniques. Reg Anesth Pain Med 30(2):143–149

    PubMed  Google Scholar 

  • Awad IT et al (2013) Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial. Can J Anaesth 60(3):259–265

    PubMed  Google Scholar 

  • Ballantyne JC et al (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86(3):598–612

    CAS  PubMed  Google Scholar 

  • Banerjee S et al (2013) Postoperative blood loss prevention in total knee arthroplasty. J Knee Surg 26(06):395–400

    PubMed  Google Scholar 

  • Bao Y et al (2012) Comparison of preincisional and postincisional parecoxib administration on postoperative pain control and cytokine response after total hip replacement. J Int Med Res 40(5):1804–1811

    CAS  PubMed  Google Scholar 

  • Barrington MJ et al (2009) Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med 34(6):534–541

    PubMed  Google Scholar 

  • Beattie WS, Badner NH, Choi P (2001) Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 93(4):853–858

    CAS  PubMed  Google Scholar 

  • Beebe MJ et al (2014) Continuous femoral nerve block using 0.125% bupivacaine does not prevent early ambulation after total knee arthroplasty. Clin Orthop Relat Res 472(5):1394–1399

    PubMed  Google Scholar 

  • Ben-Menachem E (2004) Pregabalin pharmacology and its relevance to clinical practice. Epilepsia 45(Suppl 6):13–18

    CAS  PubMed  Google Scholar 

  • Bertolini A et al (2006) Paracetamol: new vistas of an old drug. CNS Drug Rev 12(3–4):250–275

    CAS  PubMed  Google Scholar 

  • Block BM et al (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290(18):2455–2463

    CAS  PubMed  Google Scholar 

  • Bono JV et al (2012) Pharmacologic pain management before and after total joint replacement of the hip and knee. Clin Geriatr Med 28(3):459–470

    PubMed  Google Scholar 

  • Brokelman RBG, van Loon CJM, Rijnberg WJ (2003) Patient versus surgeon satisfaction after total hip arthroplasty. J Bone Joint Surg Br 85(4):495–498

    CAS  PubMed  Google Scholar 

  • Brull R et al (2007) Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg 104(4):965–974

    PubMed  Google Scholar 

  • Busch CA et al (2006) Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 88(5):959–963

    PubMed  Google Scholar 

  • Buvanendran A et al (2010) Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 110(1):199–207

    CAS  PubMed  Google Scholar 

  • Caldwell B et al (2006) Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis. J R Soc Med 99(3):132–140

    CAS  PubMed Central  PubMed  Google Scholar 

  • Capdevila X et al (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 91(1):8–15

    CAS  PubMed  Google Scholar 

  • Capdevila X, Coimbra C, Choquet O (2005) Approaches to the lumbar plexus: success, risks, and outcome. Reg Anesth Pain Med 30(2):150–162

    PubMed  Google Scholar 

  • Cappelleri G et al (2011) Does continuous sciatic nerve block improve postoperative analgesia and early rehabilitation after total knee arthroplasty? A prospective, randomized, double-blinded study. Reg Anesth Pain Med 36(5):489–492

    PubMed  Google Scholar 

  • Casati A et al (2008) 72-hour epidural infusion of 0.125% levobupivacaine following total knee replacement: a prospective, randomized, controlled, multicenter evaluation. Acta Biomed 79(1):28–35

    CAS  PubMed  Google Scholar 

  • Chan M-H et al (2012) Single-injection femoral nerve block lacks preemptive effect on postoperative pain and morphine consumption in total knee arthroplasty. Acta Anaesthesiol Taiwan 50(2):54–58

    PubMed  Google Scholar 

  • Chan E-Y et al (2013) Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty 28(4):608–613

    PubMed  Google Scholar 

  • Choi PT et al (2003) Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev (3):CD003071

    Google Scholar 

  • Clarke H et al (2009) Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty. Pain Res Manag 14(3):217–222

    PubMed Central  PubMed  Google Scholar 

  • Clarke H et al (2012) The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg 115(2):428–442

    CAS  PubMed  Google Scholar 

  • Coxib and traditional NSAID Trialists’ (CNT) Collaboration et al (2013) Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 382(9894):769–779

    Google Scholar 

  • DeLeo JA (2006) Basic science of pain. J Bone Joint Surg Am 88(Suppl 2):58–62

    PubMed  Google Scholar 

  • Dilger JA (2000) Lower extremity nerve blocks. Anesthesiol Clin North America 18(2):319–340

    CAS  PubMed  Google Scholar 

  • Dundon JM, Rymer MC, Johnson RM (2013) Total patellar skin loss from cryotherapy after total knee arthroplasty. J Arthroplasty 28(2):376.e5–7

    Google Scholar 

  • Eisen GM et al (2005) Meta-analysis: upper gastrointestinal tolerability of valdecoxib, a cyclooxygenase-2-specific inhibitor, compared with nonspecific nonsteroidal anti-inflammatory drugs among patients with osteoarthritis and rheumatoid arthritis. Aliment Pharmacol Ther 21(5):591–598

    CAS  PubMed  Google Scholar 

  • Engelman E, Cateloy F (2011) Efficacy and safety of perioperative pregabalin for post-operative pain: a meta-analysis of randomized-controlled trials. Acta Anaesthesiol Scand 55(8):927–943

    CAS  PubMed  Google Scholar 

  • Field MJ et al (1997) Evaluation of gabapentin and S-(+)-3-isobutylgaba in a rat model of postoperative pain. J Pharmacol Exp Ther 282(3):1242–1246

    CAS  PubMed  Google Scholar 

  • Fowler SJ et al (2008) Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 100(2):154–164

    CAS  PubMed  Google Scholar 

  • Goyal N et al (2013) The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res 471(1):64–75

    PubMed Central  PubMed  Google Scholar 

  • Guay J (2006) The effect of neuraxial blocks on surgical blood loss and blood transfusion requirements: a meta-analysis. J Clin Anesth 18(2):124–128

    PubMed  Google Scholar 

  • Hamber EA, Viscomi CM (1999) Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med 24(3):255–263

    CAS  PubMed  Google Scholar 

  • Hanna MN et al (2009) Regional techniques and outcome: what is the evidence? Curr Opin Anaesthesiol 22(5):672–677

    PubMed  Google Scholar 

  • Harsten A et al (2013a) General anaesthesia with multimodal principles versus intrathecal analgesia with conventional principles in total knee arthroplasty: a consecutive, randomized study. J Clin Med Res 5(1):42–48

    CAS  PubMed Central  PubMed  Google Scholar 

  • Harsten A, Kehlet H, Toksvig-Larsen S (2013b) Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial. Br J Anaesth 111(3):391–399

    CAS  PubMed  Google Scholar 

  • Hartrick CT et al (2006) Evaluation of a single-dose, extended-release epidural morphine formulation for pain after knee arthroplasty. J Bone Joint Surg Am 88(2):273–281

    PubMed  Google Scholar 

  • Himmelseher S et al (2001) Small-dose S(+)-ketamine reduces postoperative pain when applied with ropivacaine in epidural anesthesia for total knee arthroplasty. Anesth Analg 92(5):1290–1295

    CAS  PubMed  Google Scholar 

  • Horlocker TT (2010) Pain management in total joint arthroplasty: a historical review. Orthopedics 33(9 Suppl):14–19

    PubMed  Google Scholar 

  • Houmes RJ et al (1992) Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression. Anesth Analg 74(4):510–514

    CAS  PubMed  Google Scholar 

  • Hu S et al (2009) A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br 91(7):935–942. [Review] [43 refs]

    CAS  PubMed  Google Scholar 

  • Huang KS et al (1993) Influence of epinephrine as an adjuvant to epidural morphine for postoperative analgesia. Ma Zui Xue Za Zhi 31(4):245–248

    CAS  PubMed  Google Scholar 

  • Hurley R, Wu C (2009) Chapter 87. Acute postoperative pain. In: Miller’s anesthesia. Churchill Livingstone, Philadelphia, pp 2757–2781

    Google Scholar 

  • Ilfeld BM, Duke KB, Donohue MC (2010) The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 111(6):1552–1554

    PubMed Central  PubMed  Google Scholar 

  • Imasogie NN et al (2009) Ultra low-dose naloxone and tramadol/acetaminophen in elderly patients undergoing joint replacement surgery: a pilot study. Pain Res Manag 14(2):103–108

    PubMed Central  PubMed  Google Scholar 

  • Jaeger P et al (2012) Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty: a randomised study. Acta Anaesthesiol Scand 56(8):1013–1019

    CAS  PubMed  Google Scholar 

  • Jæger P et al (2013) Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 38(6):526–532

    PubMed  Google Scholar 

  • Johnson RL et al (2013) Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis. Br J Anaesth 110(4):518–528

    CAS  PubMed Central  PubMed  Google Scholar 

  • Jørgensen H et al (2001) Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev (1):CD001893 doi: 10.1002/14651858.CD001893

  • Kahl L et al (2010) Lessons learned with extended-release epidural morphine after total hip arthroplasty. Clin Orthop Relat Res 468(4):1082–1087

    PubMed Central  PubMed  Google Scholar 

  • Kang H et al (2013) Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture: a randomized, controlled study. J Bone Joint Surg Am 95(4):291–296

    PubMed  Google Scholar 

  • Kehlet H, Dahl JB (1993) The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg 77(5):1048–1056

    CAS  PubMed  Google Scholar 

  • Kullenberg B et al (2006) Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients. J Arthroplasty 21(8):1175–1179

    PubMed  Google Scholar 

  • Kurtz S et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785

    PubMed  Google Scholar 

  • Lamplot JD, Wagner ER, Manning DW (2014) Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 29(2):329–334

    PubMed  Google Scholar 

  • Lauretti GR, Righeti CCF, Mattos AL (2013) Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty. J Anaesthesiol Clin Pharmacol 29(4):503–508

    CAS  PubMed Central  PubMed  Google Scholar 

  • Levy AS, Marmar E (1993) The role of cold compression dressings in the postoperative treatment of total knee arthroplasty. Clin Orthop Relat Res 297:174–178

    PubMed  Google Scholar 

  • Lin J, Zhang L, Yang H (2013) Perioperative administration of selective cyclooxygenase-2 inhibitors for postoperative pain management in patients after total knee arthroplasty. J Arthroplasty 28(2):207–213.e2

    PubMed  Google Scholar 

  • Liu J et al (2013) Neuraxial anesthesia decreases postoperative systemic infection risk compared with general anesthesia in knee arthroplasty. Anesth Analg 117(4):1010–1016

    PubMed Central  PubMed  Google Scholar 

  • Macario A, Royal MA (2011) A literature review of randomized clinical trials of intravenous acetaminophen (paracetamol) for acute postoperative pain. Pain Pract 11(3):290–296

    PubMed  Google Scholar 

  • Macfarlane AJR et al (2009) Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. Br J Anaesth 103(3):335–345

    CAS  PubMed  Google Scholar 

  • Martin SS et al (2002) Does cryotherapy affect intraarticular temperature after knee arthroscopy? Clin Orthop Relat Res 400:184–189

    PubMed  Google Scholar 

  • Mathiesen O et al (2008) Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth 101(4):535–541

    CAS  PubMed  Google Scholar 

  • Meunier A, Aspenberg P, Good L (2009) Celecoxib does not appear to affect prosthesis fixation in total knee replacement: a randomized study using radiostereometry in 50 patients. Acta Orthop 80(1):46–50

    PubMed Central  PubMed  Google Scholar 

  • Moore RA et al (2005) Tolerability and adverse events in clinical trials of celecoxib in osteoarthritis and rheumatoid arthritis: systematic review and meta-analysis of information from company clinical trial reports. Arthritis Res Ther 7(3):R644–R665

    CAS  PubMed Central  PubMed  Google Scholar 

  • Morrison RS et al (2003) The impact of post-operative pain on outcomes following hip fracture. Pain 103(3):303–311

    PubMed  Google Scholar 

  • Murphy TP et al (2012) Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty? Clin Orthop Relat Res 470(4):1151–1157

    PubMed Central  PubMed  Google Scholar 

  • Neuburger M et al (2007) Inflammation and infection complications of 2285 perineural catheters: a prospective study. Acta Anaesthesiol Scand 51(1):108–114

    CAS  PubMed  Google Scholar 

  • Neuman MD et al (2012) Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 117(1):72–92

    CAS  PubMed  Google Scholar 

  • O’Neal JB (2013) The utility of intravenous acetaminophen in the perioperative period. Front Public Health 1:25

    PubMed Central  PubMed  Google Scholar 

  • Ozen M et al (2006) The effect of 3-in-1 femoral nerve block with ropivacaine 0.375% on postoperative morphine consumption in elderly patients after total knee replacement surgery. Agri 18(4):44–50

    PubMed  Google Scholar 

  • Pang WW et al (1999) Comparison of patient-controlled analgesia (PCA) with tramadol or morphine. Can J Anaesth 46(11):1030–1035

    CAS  PubMed  Google Scholar 

  • Parvizi J, Miller A, Gandhi K (2011) Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 93(11):1075–1084

    PubMed  Google Scholar 

  • Paul JE et al (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113(5):1144–1162

    PubMed  Google Scholar 

  • Pergolizzi JV Jr et al (2012) Continuous multimechanistic postoperative analgesia: a rationale for transitioning from intravenous acetaminophen and opioids to oral formulations. Pain Pract 12(2):159–173

    PubMed  Google Scholar 

  • Persson P-E, Nilsson OS, Berggren A-M (2005) Do non-steroidal anti-inflammatory drugs cause endoprosthetic loosening? A 10-year follow-up of a randomized trial on ibuprofen for prevention of heterotopic ossification after hip arthroplasty. Acta Orthop 76(6):735–740

    PubMed  Google Scholar 

  • Rathmell JP et al (2003) Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty. Anesth Analg 97(5):1452–1457

    CAS  PubMed  Google Scholar 

  • Remérand F et al (2009) The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study. Anesth Analg 109(6):1963–1971

    PubMed  Google Scholar 

  • Renner B et al (2012) Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief. Eur J Pain (London, England) 16(6):838–848

    CAS  Google Scholar 

  • Richman JM et al (2006) Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 102(1):248–257

    PubMed  Google Scholar 

  • Rodgers A et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ (Clinical research ed) 321(7275):1493

    CAS  Google Scholar 

  • Scott LJ, Perry CM (2000) Tramadol: a review of its use in perioperative pain. Drugs 60(1):139–176

    CAS  PubMed  Google Scholar 

  • Shneker BF, McAuley JW (2005) Pregabalin: a new neuromodulator with broad therapeutic indications. Ann Pharmacother 39(12):2029–2037

    CAS  PubMed  Google Scholar 

  • Siddiqui ZI et al (2007) Continuous lumbar plexus block provides improved analgesia with fewer side effects compared with systemic opioids after hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med 32(5):393–398

    PubMed  Google Scholar 

  • Sinatra RS et al (2005) Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology 102(4):822–831

    CAS  PubMed  Google Scholar 

  • Sinatra RS et al (2012) Intravenous acetaminophen for pain after major orthopedic surgery: an expanded analysis. Pain Pract 12(5):357–365

    PubMed  Google Scholar 

  • Singelyn FJ et al (1998) 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 87(1):88–92

    CAS  PubMed  Google Scholar 

  • Singh JA (2011) Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J 5:80–85

    PubMed Central  PubMed  Google Scholar 

  • Smith WL, DeWitt DL, Garavito RM (2000) Cyclooxygenases: structural, cellular, and molecular biology. Annu Rev Biochem 69:145–182

    CAS  PubMed  Google Scholar 

  • Soto Mesa D et al (2012) Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block. Rev Esp Anestesiol Reanim 59(4):204–209

    CAS  PubMed  Google Scholar 

  • Specht K et al (2011) No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty. Acta Orthop 82(3):315–320

    PubMed Central  PubMed  Google Scholar 

  • Stiller C-O et al (2007) The addition of tramadol to morphine via patient-controlled analgesia does not lead to better post-operative pain relief after total knee arthroplasty. Acta Anaesthesiol Scand 51(3):322–330

    CAS  PubMed  Google Scholar 

  • Stubhaug A, Grimstad J, Breivik H (1995) Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind, placebo and standard active drug comparison. Pain 62(1):111–118

    CAS  PubMed  Google Scholar 

  • Suzuki M (2009) Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management. Curr Opin Anaesthesiol 22(5):618–622

    PubMed  Google Scholar 

  • Tammachote N et al (2013) Is pain after TKA better with periarticular injection or intrathecal morphine? Clin Orthop Relat Res 471(6):1992–1999

    PubMed Central  PubMed  Google Scholar 

  • Viscusi ER (2005) Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg 105(1):176–183. Available at: http://ovidsp.ovid.com.ezproxy2.library.drexel.edu/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=ovfth&AN=00000539-200511001-00003. Accessed 6 Jan 2014

  • Wall PD (1988) The prevention of postoperative pain. Pain 33(3):289–290

    CAS  PubMed  Google Scholar 

  • Wheeler M et al (2002) Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain 3(3):159–180

    PubMed  Google Scholar 

  • Widmer B et al (2013) Incidence and severity of complications due to femoral nerve blocks performed for knee surgery. Knee 20(3):181–185

    PubMed  Google Scholar 

  • Wiegel M et al (2007) Complications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients. Anesth Analg 104(6):1578–1582, table of contents

    PubMed  Google Scholar 

  • Williams D et al (2013) Continuous infusion of bupivacaine following total knee arthroplasty: a randomized control trial pilot study. J Arthroplasty 28(3):479–484

    PubMed  Google Scholar 

  • Zhang J, Ho K-Y, Wang Y (2011) Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth 106(4):454–462

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Rothman Institute of Orthopaedics at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Priscilla K. Cavanaugh, Snir Heller & Javad Parvizi

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  1. Priscilla K. Cavanaugh
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  2. Snir Heller
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Correspondence to Priscilla K. Cavanaugh .

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  1. Humanitas Clinical and Research Center, Milan, Italy

    Andrea Baldini

  2. San Donato Hospital, Arezzo, Italy

    Patrizio Caldora

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Cavanaugh, P.K., Heller, S., Parvizi, J. (2015). Dealing with Pain Using a “Fast-Track” (Multimodal) Protocol: The Experience from the United States. In: Baldini, A., Caldora, P. (eds) Perioperative Medical Management for Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-07203-6_16

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