Multimodal analgesia without parenteral narcotics for total knee arthroplasty.
Use of parenteral narcotics after total knee arthroplasty is considered by most orthopedic surgeons to be the standard of care. This study tested the hypothesis that a multimodal oral pain medication protocol could control pain and minimize complications of parenteral narcotics. Postoperative oral analgesia was augmented with either continuous epidural infusion or continuous femoral infusion using ropivacaine only. Seventy patients had total knee arthroplasty with a protocol that included preemptive oral analgesics, epidural anesthesia, pericapsular analgesic injection, and postoperative analgesia without parenteral opioids. The average daily pain score was less than 4 out of 10, nausea occurred in 15 patients (21%), emesis in 1 patient (1.4%), and there were no severe complications. This study proved the hypothesis that pain after total knee arthroplasty could be effectively managed without routine use of parenteral opioids.
The Arthritis Institute, Inglewood, California 90301, USA.
Lawrence D
LD
Dorr
Julio
J
Raya
William T
WT
Long
Myriam
M
Boutary
Leigh Ellen
LE
Sirianni
D000284:Administration, Oral; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local; D019645:Arthroplasty, Replacement, Knee; D001241:Aspirin / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D000068579:Celecoxib; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005267:Femoral Nerve / Q000187:drug effects; D006621:Hip Joint / Q000187:drug effects; D006801:Humans; D007270:Injections, Intra-Articular; D007555:Isoxazoles / Q000008:administration & dosage*; D020910:Ketorolac / Q000008:administration & dosage; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage*; D000077212:Ropivacaine; D013449:Sulfonamides / Q000008:administration & dosage*; D000096926:Benzenesulfonamides
D000577:Amides; D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D001241:Aspirin; D000068579:Celecoxib; D007555:Isoxazoles; D020910:Ketorolac; D011720:Pyrazoles; D000077212:Ropivacaine; D013449:Sulfonamides; C406224:valdecoxib; D000096926:Benzenesulfonamides