Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center.
Improvements in pain management techniques in the last decade have had a major impact on the practice of total hip and knee arthroplasty (THA and TKA). Although there are a number of treatment options for postoperative pain, a gold standard has not been established. However, there appears to be a shift towards multimodal approaches using regional anesthesia to minimize narcotic consumption and to avoid narcotic-related side effects. Over the last 10 years, we have used intravenous patient-controlled analgesia (PCA), femoral nerve block (FNB), and continuous epidural infusions for 24 and 48 hours with and without FNB. Unfortunately, all of these techniques had shortcomings, not the least of which was suboptimal pain control and unwanted side effects. Our practice has currently evolved to using a multimodal protocol that emphasizes local periarticular injections while minimizing the use of parenteral narcotics. Multimodal protocols after THA and TKA have been a substantial advance; they provide better pain control and patient satisfaction, lower overall narcotic consumption, reduce hospital stay, and improve function while minimizing complications. Although no pain protocol is ideal, it is clear that patients should have optimum pain control after TKA and THA for enhanced satisfaction and function.


METHODS
Level V, expert opinion. See the Guidelines for Authors for a complete description of levels of evidence.
Maheshwari
Aditya V
AV
Hospital for Special Surgery, 535 East 70th Street, 6th floor, New York, NY 10021, USA.
Blum
Yossef C
YC
Shekhar
Laghvendu
L
Ranawat
Amar S
AS
Ranawat
Chitranjan S
CS
D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation; D005267:Femoral Nerve; D006801:Humans; D007270:Injections, Intra-Articular; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010353:Patient Education as Topic; D020246:Venous Thrombosis / Q000517:prevention & control
D000701:Analgesics, Opioid