title: Assuring a painless total hip arthroplasty: a multimodal approach emphasizing peripheral nerve blocks.
abstract: A highly effective comprehensive multimodal pain protocol has evolved at our institution for both primary and revision hip and knee arthroplasty. At the center of this protocol are peripheral nerve blocks to deliver postoperative pain relief. Total hip arthroplasty patients receive a lumbar plexus block with an indwelling catheter. Total knee arthroplasty patients receive a femoral nerve block with an indwelling catheter and also get a single-shot sciatic nerve block. Before surgery, patients are given a long-acting oral narcotic medication and a nonsteroidal anti-inflammatory. After surgery, oral medications are given on a set schedule and include acetaminophen, a nonsteroidal anti-inflammatory, and a long-acting oral narcotic. Outstanding pain control is achieved without parenteral narcotics and allows early physical therapy, early return to self-care, and improved patient satisfaction.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Pagnano
authors.forename: James
authors.initials: J
authors.lastname: Hebl
authors.forename: Terese
authors.initials: T
authors.lastname: Horlocker
mesh_terms: D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010525:Peripheral Nerves; D011184:Postoperative Period; D011300:Preoperative Care; D015203:Reproducibility of Results; D016138:Walking
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal