PDF herunterladen
J Knee Surg 2016; 29(02): 169-178
DOI: 10.1055/s-0035-1549027
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

New and Common Perioperative Pain Management Techniques in Total Knee Arthroplasty

Randa K. Elmallah
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Jeffrey J. Cherian
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Todd P. Pierce
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Julio J. Jauregui
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Steven F. Harwin
2   Department of Orthopaedic Surgery, Mount Sinai Beth Israel Medical Center, New York, New York
,
Michael A. Mont
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
› Institutsangaben
Weitere Informationen

Publikationsverlauf

20. Januar 2015

25. Januar 2015

Publikationsdatum:
18. April 2015 (online)

    Lizenzen und Reprints

Abstract

Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. As a result, newer pain control modalities have been used to try to reduce the use of opioids while providing adequate pain relief. Currently, there are no clear guidelines or evidence for an optimum postoperative TKA analgesic regimen. Our aim was to evaluate the recent literature and provide a summary of the newer perioperative analgesic modalities. Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed.

Keywords

knee - pain management - total knee arthroplasty - blocks - injections
 

  • References

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (4) 780-785
    CrossrefPubMedGoogle Scholar
  • 2 Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29 (2) 329-334
    CrossrefPubMedGoogle Scholar
  • 3 Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 2002; 10 (2) 117-129
    PubMedGoogle Scholar
  • 4 Jiang J, Teng Y, Fan Z, Khan MS, Cui Z, Xia Y. The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J Arthroplasty 2013; 28 (10) 1882-1887
    CrossrefPubMedGoogle Scholar
  • 5 Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anesth 2001; 13 (7) 524-539
    CrossrefPubMedGoogle Scholar
  • 6 Capdevila X, Macaire P, Dadure C , et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg 2002; 94 (6) 1606-1613
    CrossrefPubMedGoogle Scholar
  • 7 Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev 2003; (3) CD003071
    PubMedGoogle Scholar
  • 8 Musclow SL, Bowers T, Vo H, Glube M, Nguyen T. Long-acting morphine following hip or knee replacement: a randomized, double-blind and placebo-controlled trial. Pain Res Manag 2012; 17 (2) 83-88
    PubMedGoogle Scholar
  • 9 Seidenberg AB, An YH. Is there an inhibitory effect of COX-2 inhibitors on bone healing?. Pharmacol Res 2004; 50 (2) 151-156
    CrossrefPubMedGoogle Scholar
  • 10 Simon AM, Manigrasso MB, O'Connor JP. Cyclo-oxygenase 2 function is essential for bone fracture healing. J Bone Miner Res 2002; 17 (6) 963-976
    CrossrefPubMedGoogle Scholar
  • 11 Goodman S, Ma T, Trindade M , et al. COX-2 selective NSAID decreases bone ingrowth in vivo. J Orthop Res 2002; 20 (6) 1164-1169
    CrossrefPubMedGoogle Scholar
  • 12 Jacobsson SA, Djerf K, Ivarsson I, Wahlström O. Effect of diclofenac on fixation of hydroxyapatite-coated implants. An experimental study. J Bone Joint Surg Br 1994; 76 (5) 831-833
    PubMedGoogle Scholar
  • 13 Peters CL, Shirley B, Erickson J. The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty. J Arthroplasty 2006; 21 (6) (Suppl. 02) 132-138
    CrossrefPubMedGoogle Scholar
  • 14 Shen B, Tang X, Yang J , et al. Effects of perioperative administration of celecoxib on pain management and recovery of function after total knee replacement [in Chinese]. Zhonghua Wai Ke Za Zhi 2009; 47 (2) 116-119
    PubMedGoogle Scholar
  • 15 Kazerooni R, Bounthavong M, Tran JN, Boggie DT, Meyer RS. Retrospective evaluation of inpatient celecoxib use after total hip and knee arthroplasty at a Veterans Affairs Medical Center. J Arthroplasty 2012; 27 (6) 1033-1040
    CrossrefPubMedGoogle Scholar
  • 16 Gong L, Dong JY, Li ZR. Effects of combined application of muscle relaxants and celecoxib administration after total knee arthroplasty (TKA) on early recovery: a randomized, double-blind, controlled study. J Arthroplasty 2013; 28 (8) 1301-1305
    CrossrefPubMedGoogle Scholar
  • 17 Jain P, Jolly A, Bholla V, Adatia S, Sood J. Evaluation of efficacy of oral pregabalin in reducing postoperative pain in patients undergoing total knee arthroplasty. Indian J Orthop 2012; 46 (6) 646-652
    CrossrefPubMedGoogle Scholar
  • 18 Clarke HA, Katz J, McCartney CJ , et al. Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block. Br J Anaesth 2014; 113 (5) 855-864
    CrossrefPubMedGoogle Scholar
  • 19 Ho KY, Tay W, Yeo MC , et al. Duloxetine reduces morphine requirements after knee replacement surgery. Br J Anaesth 2010; 105 (3) 371-376
    CrossrefPubMedGoogle Scholar
  • 20 Buvanendran A, Kroin JS, Della Valle CJ, Kari M, Moric M, Tuman KJ. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 2010; 110 (1) 199-207
    CrossrefPubMedGoogle Scholar
  • 21 Fu PL, Xiao J, Zhu YL , et al. Efficacy of a multimodal analgesia protocol in total knee arthroplasty: a randomized, controlled trial. J Int Med Res 2010; 38 (4) 1404-1412
    CrossrefPubMedGoogle Scholar
  • 22 Danninger T, Opperer M, Memtsoudis SG. Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks. World J Orthod 2014; 5 (3) 225-232
    CrossrefPubMedGoogle Scholar
  • 23 Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology 2013; 118 (2) 409-415
    CrossrefPubMedGoogle Scholar
  • 24 Paul JE, Arya A, Hurlburt L , et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 2010; 113 (5) 1144-1162
    CrossrefPubMedGoogle Scholar
  • 25 Duarte VM, Fallis WM, Slonowsky D, Kwarteng K, Yeung CK. Effectiveness of femoral nerve blockade for pain control after total knee arthroplasty. J Perianesth Nurs 2006; 21 (5) 311-316
    CrossrefPubMedGoogle Scholar
  • 26 Chan EY, Fransen M, Sathappan S, Chua NH, Chan YH, Chua N. Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty 2013; 28 (4) 608-613
    CrossrefPubMedGoogle Scholar
  • 27 Sakai N, Inoue T, Kunugiza Y, Tomita T, Mashimo T. Continuous femoral versus epidural block for attainment of 120° knee flexion after total knee arthroplasty: a randomized controlled trial. J Arthroplasty 2013; 28 (5) 807-814
    CrossrefPubMedGoogle Scholar
  • 28 Charous MT, Madison SJ, Suresh PJ , et al. Continuous femoral nerve blocks: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block. Anesthesiology 2011; 115 (4) 774-781
    CrossrefPubMedGoogle Scholar
  • 29 Kwofie MK, Shastri UD, Gadsden JC , et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med 2013; 38 (4) 321-325
    CrossrefPubMedGoogle Scholar
  • 30 Memtsoudis SG, Danninger T, Rasul R , et al. Inpatient falls after total knee arthroplasty: the role of anesthesia type and peripheral nerve blocks. Anesthesiology 2014; 120 (3) 551-563
    CrossrefPubMedGoogle Scholar
  • 31 Abdallah FW, Chan VW, Gandhi R, Koshkin A, Abbas S, Brull R. The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial. Anesthesiology 2014; 121 (6) 1302-1310
    CrossrefPubMedGoogle Scholar
  • 32 Al-Zahrani T, Doais KS, Aljassir F, Alshaygy I, Albishi W, Terkawi AS. Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty. J Arthroplasty 2015; 30 (1) 149-154
    CrossrefPubMedGoogle Scholar
  • 33 Jenstrup MT, Jæger P, Lund J , et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 2012; 56 (3) 357-364
    CrossrefPubMedGoogle Scholar
  • 34 Hanson NA, Allen CJ, Hostetter LS , et al. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg 2014; 118 (6) 1370-1377
    CrossrefPubMedGoogle Scholar
  • 35 Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty 2014; 29 (11) 2224-2229
    CrossrefPubMedGoogle Scholar
  • 36 Spangehl MJ, Clarke HD, Hentz JG, Misra L, Blocher JL, Seamans DP. The Chitranjan Ranawat Award: Periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res 2015; 473 (1) 45-53
    CrossrefPubMedGoogle Scholar
  • 37 Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplasty 2014; 29 (8) 1687-1690
    CrossrefPubMedGoogle Scholar
  • 38 Pandazi A, Kanellopoulos I, Kalimeris K , et al. Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia. Arch Orthop Trauma Surg 2013; 133 (11) 1607-1612
    CrossrefPubMedGoogle Scholar
  • 39 Teng Y, Jiang J, Chen S , et al. Periarticular multimodal drug injection in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (8) 1949-1957
    CrossrefPubMedGoogle Scholar
  • 40 Busch CA, Shore BJ, Bhandari R , et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006; 88 (5) 959-963
    CrossrefPubMedGoogle Scholar
  • 41 Kwon SK, Yang IH, Bai SJ, Han CD. Periarticular injection with corticosteroid has an additional pain management effect in total knee arthroplasty. Yonsei Med J 2014; 55 (2) 493-498
    CrossrefPubMedGoogle Scholar
  • 42 Ranade VV. Drug delivery systems. 1. site-specific drug delivery using liposomes as carriers. J Clin Pharmacol 1989; 29 (8) 685-694
    CrossrefPubMedGoogle Scholar
  • 43 Bramlett K, Onel E, Viscusi ER, Jones K. A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty. Knee 2012; 19 (5) 530-536
    CrossrefPubMedGoogle Scholar
  • 44 Dasta J, Ramamoorthy S, Patou G, Sinatra R. Bupivacaine liposome injectable suspension compared with bupivacaine HCl for the reduction of opioid burden in the postsurgical setting. Curr Med Res Opin 2012; 28 (10) 1609-1615
    CrossrefPubMedGoogle Scholar