title: New modalities of pain treatment after outpatient orthopaedic surgery.
abstract: Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored.
authors.affiliation: Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France. Electronic address: marc.beaussier@sat.aphp.fr.
authors.forename: M
authors.initials: M
authors.lastname: Beaussier
authors.affiliation: Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Sciard
authors.affiliation: Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Sautet
mesh_terms: D015667:Acupuncture Analgesia / Q000379:methods; D000556:Ambulatory Surgical Procedures; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000765:Anesthesia, Conduction / Q000379:methods; D000779:Anesthetics, Local / Q000627:therapeutic use*; D017679:Cryotherapy / Q000379:methods; D006699:Home Care Services; D006801:Humans; D006990:Hypnosis / Q000379:methods; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures; D059408:Pain Management; D010149:Postoperative Pain / Q000628:therapy*; D010525:Peripheral Nerves
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local
keywords: Ambulatory; Local infiltration; Multimodal analgesia; Orthopaedic surgery; Peripheral nerve block; Postoperative pain; Regional analgesia