Update of Multimodal Pain Management Strategies for Total Knee Arthroplasty
Nikom Noree MD1, Srihatach Ngarmukos MD1, Aree Tanavalee MD1, Wirinaree Kampitak MD2
Affiliation : 1 Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 2 Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Total knee arthroplasty [TKA] has traditionally been one of the most painful orthopedic procedures. Postoperative pain control in the past depended on high doses of opioids, resulting in dizziness and nausea, delayed ambulation, and prolonged hospital stays. Over the last decade, multimodal pain control has been developed that provides excellent pain control and reduces opioid consumption. The key principle is the use of a variety of interventions that affect different sites in the pain pathway. Multimodal pain management for TKA includes preemptive analgesia, regional anesthesia, and local infiltrative anesthesia (periarticular injection) as well as various oral and intravenous pain medications such as NSAIDs, COX-2 inhibitors, and gabapentinoids. The goal of this review is to provide an update of current knowledge of multimodal pain management for TKA.
Keywords : Multimodal analgesia; Periarticular infiltration; Total knee arthroplasty
