J Knee Surg 2018; 31(06): 504-513
DOI: 10.1055/s-0037-1604152
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pain Control in Total Knee Arthroplasty

Randa K. Elmallah
Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
,
Morad Chughtai
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Anton Khlopas
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Jared M. Newman
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Kim L. Stearns
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Martin Roche
Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
,
Michael A. Kelly
Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey
,
Steven F. Harwin
Department of Orthopaedic Surgery, Mount Sinai West, New York, New York
,
Michael A. Mont
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

30 March 2017

31 May 2017

Publication Date:
18 July 2017 (eFirst)

Abstract

As surgical techniques and pharmacology advance, the management of postoperative pain in patients undergoing total knee arthroplasty (TKA) continues to evolve. The current standards of care are composed of multimodal pain management including opioids, nonsteroidal anti-inflammatory drugs and gabapentinoids, peripheral nerve blocks, and periarticular injections. Newer modalities are composed of delayed release local anesthetics and cryoneurolysis. To summarize the current evidence-based treatment modalities and forecast changes in the management of patients having TKAs, we reviewed available data on: (1) oral analgesics; (2) periarticular injections; (3) peripheral nerve blocks; (4) multimodal regimens; and (5) newer modalities in post-TKA pain management. Multimodal analgesic regimens that target numerous pain pathways may provide the best pain management, rehabilitation, patient satisfaction, and reduce opioid use and related side effects. Periarticular injections of delayed-release local anesthetics may further enhance pain management.