Multimodal pain management in orthopedics: implications for joint arthroplasty surgery.

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

[1]  J. Parvizi,et al.  AT THE ANNUAL MEETINGS OF THE KNEE SOCIETY The 2012 Chitranjan Ranawat Award : Intraarticular Analgesia After TKA Reduces Pain : A Randomized , Double-blinded , Placebo-controlled , Prospective Study , 2012 .

[2]  F. Noyes,et al.  The development of postoperative knee chondrolysis after intra-articular pain pump infusion of an anesthetic medication: a series of twenty-one cases. , 2012, Journal of Bone and Joint Surgery. American volume.

[3]  J. Silber,et al.  Comparative Effectiveness of Regional versus General Anesthesia for Hip Fracture Surgery in Adults , 2012, Anesthesiology.

[4]  E. Viscusi,et al.  Intravenous Acetaminophen for Pain after Major Orthopedic Surgery: An Expanded Analysis , 2012, Pain practice : the official journal of World Institute of Pain.

[5]  K. Mulhall,et al.  Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty? , 2012, Clinical orthopaedics and related research.

[6]  M. Á. B. Álvarez,et al.  Control del dolor postoperatorio en artroplastia de rodilla, bloqueo del nervio femoral con dosis única frente a bloqueo femoral continuo , 2012 .

[7]  C. Dora,et al.  Continuous Epicapsular Ropivacaine 0.3% Infusion After Minimally Invasive Hip Arthroplasty: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study Comparing Continuous Wound Infusion with Morphine Patient-Controlled Analgesia , 2012, Anesthesia and analgesia.

[8]  I. Dobrydnjov,et al.  Intraarticular vs. extraarticular ropivacaine infusion following high-dose local infiltration analgesia after total knee arthroplasty , 2011, Acta orthopaedica.

[9]  Young-Hoo Kim,et al.  Is intra-articular multimodal drug injection effective in pain management after total knee arthroplasty? A randomized, double-blinded, prospective study. , 2011, The Journal of arthroplasty.

[10]  S. Hasan,et al.  Glenohumeral chondrolysis associated with use of an intra-articular pain pump delivering local anesthetics following manipulation under anesthesia: a report of four cases. , 2011, The Journal of bone and joint surgery. American volume.

[11]  Anil Gupta,et al.  Local Infiltration Analgesia Versus Intrathecal Morphine for Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial , 2011, Anesthesia and analgesia.

[12]  H. Kehlet,et al.  High-volume infiltration analgesia in bilateral hip arthroplasty , 2011, Acta orthopaedica.

[13]  T. Horlocker.  Complications of regional anesthesia and acute pain management. , 2011, Anesthesiology clinics.

[14]  L. Køber,et al.  Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction: A Nationwide Cohort Study , 2011, Circulation.

[15]  N. Polissar,et al.  Risk factors for chondrolysis of the glenohumeral joint: a study of three hundred and seventy-five shoulder arthroscopic procedures in the practice of an individual community surgeon. , 2011, The Journal of bone and joint surgery. American volume.

[16]  H. Kehlet,et al.  Intraoperative Local Infiltration Analgesia for Early Analgesia After Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial , 2011, Regional Anesthesia & Pain Medicine.

[17]  C. L. Jeng,et al.  Complications of peripheral nerve blocks. , 2010, British journal of anaesthesia.

[18]  K. Søballe,et al.  A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty , 2010, Acta orthopaedica.

[19]  T. Horlocker.  Pain management in total joint arthroplasty: a historical review. , 2010, Orthopedics.

[20]  R. Bourne,et al.  The Efficacy of Periarticular Multimodal Drug Infiltration in Total Hip Arthroplasty , 2010, Clinical orthopaedics and related research.

[21]  Yl Wu,et al.  Efficacy of a Multimodal Analgesia Protocol in Total Knee Arthroplasty: A Randomized, Controlled Trial , 2010, The Journal of international medical research.

[22]  J. Parvizi,et al.  Lessons Learned with Extended-release Epidural Morphine after Total Hip Arthroplasty , 2010, Clinical orthopaedics and related research.

[23]  W. Hozack,et al.  A prospective evaluation of 2 different pain management protocols for total hip arthroplasty. , 2010, The Journal of arthroplasty.

[24]  C. Chang,et al.  Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[25]  J. Kroin,et al.  Perioperative Oral Pregabalin Reduces Chronic Pain After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial , 2010, Anesthesia and analgesia.

[26]  R. Dworkin,et al.  Treatment of neuropathic pain: an overview of recent guidelines. , 2009, The American journal of medicine.

[27]  V. Chan,et al.  Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. , 2009, British journal of anaesthesia.

[28]  B. Min,et al.  Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty , 2009, Clinics in orthopedic surgery.

[29]  Shuozhuo Hu,et al.  A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. , 2009, The Journal of bone and joint surgery. British volume.

[30]  J. Katz,et al.  Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty. , 2009, Pain research & management.

[31]  X. Capdevila,et al.  Infectious Risk of Continuous Peripheral Nerve Blocks , 2009, Anesthesiology.

[32]  D. O. Warner,et al.  The Economic Implications of a Multimodal Analgesic Regimen for Patients Undergoing Major Orthopedic Surgery: A Comparative Study of Direct Costs , 2008, Regional Anesthesia & Pain Medicine.

[33]  C. Lavernia,et al.  Multimodal pain management and arthrofibrosis. , 2008, The Journal of arthroplasty.

[34]  Ching-Chuan Jiang,et al.  Perioperative celecoxib administration for pain management after total knee arthroplasty – A randomized, controlled study , 2008, BMC musculoskeletal disorders.

[35]  P. Myles,et al.  Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. , 2008, British journal of anaesthesia.

[36]  C. Ranawat,et al.  Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. , 2007, The Journal of arthroplasty.

[37]  S. Kurtz,et al.  Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. , 2007, The Journal of bone and joint surgery. American volume.

[38]  B. Krogh,et al.  Postoperative analgesia in total hip arthroplasty: A randomized double-blinded, placebo-controlled study on peroperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration , 2007, Acta orthopaedica.

[39]  C. Logemann,et al.  Management of common opioid-induced adverse effects. , 2006, American family physician.

[40]  Z. Zuo,et al.  A Comparison of Neuraxial Block Versus General Anesthesia for Elective Total Hip Replacement: A Meta-Analysis , 2006, Anesthesia and analgesia.

[41]  C. Peters,et al.  The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty. , 2006, The Journal of arthroplasty.

[42]  S. Ganapathy,et al.  Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. , 2006, The Journal of bone and joint surgery. American volume.

[43]  M. Guertin,et al.  A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. , 2006, The Journal of bone and joint surgery. American volume.

[44]  Christopher L. Wu,et al.  Does Continuous Peripheral Nerve Block Provide Superior Pain Control to Opioids? A Meta-Analysis , 2006, Anesthesia and analgesia.

[45]  S. Straube,et al.  Effect of preoperative Cox‐II‐selective NSAIDs (coxibs) on postoperative outcomes: A systematic review of randomized studies , 2005, Acta anaesthesiologica Scandinavica.

[46]  E. Viscusi,et al.  Efficacy and Safety of Single and Repeated Administration of 1 Gram Intravenous Acetaminophen Injection (Paracetamol) for Pain Management after Major Orthopedic Surgery , 2005, Anesthesiology.

[47]  J. Apfelbaum,et al.  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 , 2004, Anesthesiology.

[48]  Kathryn E. McGoldrick,et al.  Postoperative Pain Experience: Results From a National Survey Suggest Postoperative Pain Continues to be Undermanaged , 2004 .

[49]  A. Rosenberg,et al.  Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement: a randomized controlled trial. , 2003, JAMA.

[50]  Richard Taylor,et al.  Intrathecal Morphine for Postoperative Analgesia: A Randomized, Controlled, Dose-Ranging Study After Hip and Knee Arthroplasty , 2003, Anesthesia and analgesia.

[51]  J. Chelly,et al.  Anesthesia and postoperative analgesia: outcomes following orthopedic surgery. , 2003, Orthopedics.

[52]  R. Morrison,et al.  The impact of post-operative pain on outcomes following hip fracture , 2003, Pain.

[53]  W. J. Rijnberg,et al.  Patient versus surgeon satisfaction after total hip arthroplasty. , 2003, The Journal of bone and joint surgery. British volume.

[54]  B. Williams,et al.  Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. , 2002, Journal of clinical anesthesia.

[55]  M. Ashburn,et al.  Adverse events associated with postoperative opioid analgesia: a systematic review. , 2002, The journal of pain : official journal of the American Pain Society.

[56]  X. Capdevila,et al.  Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. , 1999, Anesthesiology.

[57]  A. Davies,et al.  Understanding patient willingness to recommend and return: a strategy for prioritizing improvement opportunities. , 1999, The Joint Commission journal on quality improvement.

[58]  C. Moote.  The prevention of postoperative pain , 1994, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[59]  Y. Hui,et al.  Influence of epinephrine as an adjuvant to epidural morphine for postoperative analgesia. , 1993, Ma zui xue za zhi = Anaesthesiologica Sinica.

[60]  H. Kehlet,et al.  The Value of “Multimodal” or “Balanced Analgesia” in Postoperative Pain Treatment , 1993, Anesthesia and analgesia.

[61]  D. Soto Mesa,et al.  [Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block]. , 2012, Revista espanola de anestesiologia y reanimacion.

[62]  J. Parvizi,et al.  Postoperative pain management techniques in hip and knee arthroplasty. , 2009, Instructional course lectures.

[63]  D. G. Nuelle,et al.  Minimal incision protocols for anesthesia, pain management, and physical therapy with standard incisions in hip and knee arthroplasties: the effect on early outcomes. , 2007, The Journal of arthroplasty.

[64]  D. Duthie,et al.  Adverse effects of opioid analgesic drugs. , 1987, British journal of anaesthesia.