J Knee Surg 2020; 33(04): 320-327
DOI: 10.1055/s-0039-1698746
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

David Gregory Fanelli
1   Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
,
To-Nhu Vu
1   Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
› Author Affiliations
Further Information

Publication History

12 August 2019

01 September 2019

Publication Date:
22 October 2019 (online)

Abstract

The multiligament knee injury presents as a complex injury pattern that has substantial potential to cause long-term disability. Patients who sustain this injury pattern experience significant pain not only immediately following injury but also throughout the perioperative and postoperative period. Treating pain with major orthopaedic procedures is challenging but technical success of a surgical repair becomes trivial when pain is not effectively managed. This article will (1) provide an outline of the types of pain most often sustained in the multiligament knee injury, (2) outline the phases of pain management for this injury, and (3) provide an overview of persistent postoperative pain. The principles of multimodal analgesia in combination with effective regional anesthesia and attentive intraoperative management can position patients for successful rehabilitation and recovery.

 
  • References

  • 1 Fanelli GC. , Ed. The Multiple Ligament Injured Knee. 3rd ed. New York, NY: Springer; 2019
  • 2 Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain 2011; 152 (03) 566-572
  • 3 Rosseland LA, Solheim N, Stubhaug A. Pain and disability 1 year after knee arthroscopic procedures. Acta Anaesthesiol Scand 2008; 52 (03) 332-337
  • 4 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 (06) 1606-1613
  • 5 Horlocker TT, Kopp SL, Pagnano MW, Hebl JR. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg 2006; 14 (03) 126-135
  • 6 Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 1999; 353 (9168): 1959-1964
  • 7 Bouhassira D, Attal N, Alchaar H. , et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114 (1-2): 29-36
  • 8 Mook WR, Ligh CA, Moorman III CT, Leversedge FJ. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Surg 2013; 21 (06) 343-354
  • 9 Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother 2009; 9 (05) 745-758
  • 10 Burns LC, Ritvo SE, Ferguson MK, Clarke H, Seltzer Z, Katz J. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review. J Pain Res 2015; 8 (08) 21-32
  • 11 Sullivan M, Tanzer M, Reardon G, Amirault D, Dunbar M, Stanish W. The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty. Pain 2011; 152 (10) 2287-2293
  • 12 Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P. Demographic and psychosocial predictors of acute perioperative pain for total knee arthroplasty. Pain Res Manag 2007; 12 (03) 185-194
  • 13 Wertli MM, Burgstaller JM, Weiser S, Steurer J, Kofmehl R, Held U. Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain: a systematic review. Spine 2014; 39 (03) 263-273
  • 14 Bierke S, Petersen W. Influence of anxiety and pain catastrophizing on the course of pain within the first year after uncomplicated total knee replacement: a prospective study. Arch Orthop Trauma Surg 2017; 137 (12) 1735-1742
  • 15 Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 2017; 152 (07) 691-697
  • 16 Beverly A, Kaye AD, Ljungqvist O, Urman RD. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) guidelines. Anesthesiol Clin 2017; 35 (02) e115-e143
  • 17 Gostin LO, Hodge Jr JG, Noe SA. Reframing the opioid epidemic as a national emergency. JAMA 2017; 318 (16) 1539-1540
  • 18 Hansen RN, Pham A, Strassels SA, Balaban S, Wan GJ. Comparative analysis of length of stay and inpatient costs for orthopedic surgery patients treated with IV acetaminophen and IV opioids vs. IV opioids alone for post-operative pain. Adv Ther 2016; 33 (09) 1635-1645
  • 19 Grundmann U, Wörnle C, Biedler A, Kreuer S, Wrobel M, Wilhelm W. The efficacy of the non-opioid analgesics parecoxib, paracetamol and metamizol for postoperative pain relief after lumbar microdiscectomy. Anesth Analg 2006; 103 (01) 217-222
  • 20 Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010; 110 (04) 1170-1179
  • 21 Westrich GH, Birch GA, Muskat AR. , et al. Intravenous vs oral acetaminophen as a component of multimodal analgesia after total hip arthroplasty: a randomized, blinded trial. J Arthroplasty 2019; 34 (7S): S215-S220
  • 22 Gupta A, Bah M. NSAIDs in the treatment of postoperative pain. Curr Pain Headache Rep 2016; 20 (11) 62
  • 23 Takada M, Fukusaki M, Terao Y. , et al. Preadministration of flurbiprofen suppresses prostaglandin production and postoperative pain in orthopedic patients undergoing tourniquet inflation. J Clin Anesth 2007; 19 (02) 97-100
  • 24 Takada M, Fukusaki M, Terao Y. , et al. Postoperative analgesic effect of preoperative intravenous flurbiprofen in arthroscopic rotator cuff repair. J Anesth 2009; 23 (04) 500-503
  • 25 Buvanendran A, Kroin JS, Tuman KJ. , 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. JAMA 2003; 290 (18) 2411-2418
  • 26 Wheatley BM, Nappo KE, Christensen DL, Holman AM, Brooks DI, Potter BK. Effect of NSAIDs on bone healing rates: a meta-analysis. J Am Acad Orthop Surg 2019; 27 (07) e330-e336
  • 27 Marquez-Lara A, Hutchinson ID, Nuñez Jr F, Smith TL, Miller AN. Nonsteroidal anti-inflammatory drugs and bone-healing: a systematic review of research quality. JBJS Rev 2016; 4 (03) 1-14
  • 28 Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 2013; 110 (02) 191-200
  • 29 Samona J, Cook C, Krupa K. , et al. Effect of intraoperative dexamethasone on pain scores and narcotic consumption in patients undergoing total knee arthroplasty. Orthop Surg 2017; 9 (01) 110-114
  • 30 Vargas III JH, Ross DG. Corticosteroids and anterior cruciate ligament repair. Am J Sports Med 1989; 17 (04) 532-534
  • 31 Polderman J, Farhang-Razi V, Van Dieren S. , et al. Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev 2018; (11) 1-116
  • 32 Mathiesen O, Møiniche S, Dahl JB. Gabapentin and postoperative pain: a qualitative and quantitative systematic review, with focus on procedure. BMC Anesthesiol 2007; 7 (06) 6
  • 33 Zhang J, Ho KY, Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth 2011; 106 (04) 454-462
  • 34 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 (01) 199-207
  • 35 Han C, Kuang MJ, Ma JX, Ma XL. Is pregabalin effective and safe in total knee arthroplasty? A PRISMA-compliant meta-analysis of randomized-controlled trials. Medicine (Baltimore) 2017; 96 (26) e6947
  • 36 YaDeau JT, Lin Y, Mayman DJ. , et al. Pregabalin and pain after total knee arthroplasty: a double-blind, randomized, placebo-controlled, multidose trial. Br J Anaesth 2015; 115 (02) 285-293
  • 37 Brinck EC, Tiippana E, Heesen M. , et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev 2018; 12: CD012033
  • 38 Remérand F, Le Tendre C, Baud A. , et al. The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study. Anesth Analg 2009; 109 (06) 1963-1971
  • 39 Adam F, Chauvin M, Du Manoir B, Langlois M, Sessler DI, Fletcher D. Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty. Anesth Analg 2005; 100 (02) 475-480
  • 40 Menigaux C, Fletcher D, Dupont X, Guignard B, Guirimand F, Chauvin M. The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg 2000; 90 (01) 129-135
  • 41 Li Y, Shi J, Yang BF. , et al. Ketamine-induced ventricular structural, sympathetic and electrophysiological remodelling: pathological consequences and protective effects of metoprolol. Br J Pharmacol 2012; 165 (06) 1748-1756
  • 42 King MR, Ladha KS, Gelineau AM, Anderson TA. Perioperative dextromethorphan as an adjunct for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 2016; 124 (03) 696-705
  • 43 Sanchez Munoz MC, De Kock M, Forget P. What is the place of clonidine in anesthesia? Systematic review and meta-analyses of randomized controlled trials. J Clin Anesth 2017; 38: 140-153
  • 44 YaDeau JT, Gordon MA, Goytizolo EA. , et al. Buprenorphine, clonidine, dexamethasone, and ropivacaine for interscalene nerve blockade: a prospective, randomized, blinded, ropivacaine dose-response study. Pain Med 2016; 17 (05) 940-960
  • 45 Engelman E, Marsala C. Efficacy of adding clonidine to intrathecal morphine in acute postoperative pain: meta-analysis. Br J Anaesth 2013; 110 (01) 21-27
  • 46 Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology 2009; 111 (02) 406-415
  • 47 Li C, Qu J. Efficacy of dexmedetomidine for pain management in knee arthroscopy: a systematic review and meta-analysis. Medicine (Baltimore) 2017; 96 (43) e7938
  • 48 Schnabel A, Meyer-Frießem CH, Reichl SU, Zahn PK, Pogatzki-Zahn EM. Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials. Pain 2013; 154 (07) 1140-1149
  • 49 Subedi M, Bajaj S, Kumar MS, Yc M. An overview of tramadol and its usage in pain management and future perspective. Biomed Pharmacother 2019; 111: 443-451
  • 50 Beakley BD, Kaye AM, Kaye AD. Tramadol, pharmacology, side effects, and serotonin syndrome: a review. Pain Physician 2015; 18 (04) 395-400
  • 51 Ryan T, Hodge A, Holyoak R. , et al. Tramadol as an adjunct to intra-articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta-analysis. ANZ J Surg 2019; 89 (7-8): 827-832
  • 52 Dahl V, Spreng UJ, Waage M, Raeder JC. Short stay and less pain after ambulatory anterior cruciate ligament (ACL) repair: COX-2 inhibitor versus glucocorticoid versus both combined. Acta Anaesthesiol Scand 2012; 56 (01) 95-101
  • 53 Rosaeg OP, Krepski B, Cicutti N, Dennehy KC, Lui AC, Johnson DH. Effect of preemptive multimodal analgesia for arthroscopic knee ligament repair. Reg Anesth Pain Med 2001; 26 (02) 125-130
  • 54 American Society of Anesthesiologists. Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. In: Schaumburg, IL: Committee of Quality Management and Departmental Administration, American Society of Anesthesiologists; 2014: 1-2
  • 55 Mulroy MF, Larkin KL, Hodgson PS, Helman JD, Pollock JE, Liu SS. A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy. Anesth Analg 2000; 91 (04) 860-864
  • 56 Oldman M, McCartney CJ, Leung A. , et al. A survey of orthopedic surgeons' attitudes and knowledge regarding regional anesthesia. Anesth Analg 2004; 98 (05) 1486-1490
  • 57 Clark L, Robinson M, Varbanova M. Role of regional anesthesia in orthopedic trauma. Anesthesiol Clin 2014; 32 (04) 789-808
  • 58 Leathers MP, Merz A, Wong J, Scott T, Wang JC, Hame SL. Trends and demographics in anterior cruciate ligament reconstruction in the United States. J Knee Surg 2015; 28 (05) 390-394
  • 59 Masursky D, Dexter F, McCartney CJ, Isaacson SA, Nussmeier NA. Predicting orthopedic surgeons' preferences for peripheral nerve blocks for their patients. Anesth Analg 2008; 106 (02) 561-567
  • 60 Richebé P, Capdevila X, Rivat C. Persistent postsurgical pain: pathophysiology and preventative pharmacologic considerations. Anesthesiology 2018; 129 (03) 590-607
  • 61 Rivat C, Bollag L, Richebé P. Mechanisms of regional anaesthesia protection against hyperalgesia and pain chronicization. Curr Opin Anaesthesiol 2013; 26 (05) 621-625
  • 62 Krych A, Arutyunyan G, Kuzma S, Levy B, Dahm D, Stuart M. Adverse effect of femoral nerve blockade on quadriceps strength and function after ACL reconstruction. J Knee Surg 2015; 28 (01) 83-88
  • 63 Abdallah FW, Whelan DB, Chan VW. , et al. Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 2016; 124 (05) 1053-1064
  • 64 Kim DH, Lin Y, Goytizolo EA. , et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology 2014; 120 (03) 540-550
  • 65 Reddy AG, Jangale A, Reddy R, Sagi M, Gaikwad A, Reddy A. To compare effect of combined block of adductor canal block (ACB) with IPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee) and adductor canal block (ACB) alone on Total knee replacement in immediate postoperative rehabilitation. Int J Orthop Sci. 2017; 3 (02) 141-145
  • 66 Thobhani S, Scalercio L, Elliott CE. , et al. Novel regional techniques for total knee arthroplasty promote reduced hospital length of stay: an analysis of 106 patients. Ochsner J 2017; 17 (03) 233-238
  • 67 Kim DH, Beathe JC, Lin Y. , et al. Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg 2019; 129 (02) 526-535
  • 68 Kraychete D, Sakata R, Lannes Lde O, Bandeira I, Sadatsune E. Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment. Braz J Anesth. 2016; 66 (05) 505-512
  • 69 Liu SS, Buvanendran A, Rathmell JP. , et al. A cross-sectional survey on prevalence and risk factors for persistent postsurgical pain 1 year after total hip and knee replacement. Reg Anesth Pain Med 2012; 37 (04) 415-422
  • 70 Anthony CA, Westermann RW, Bedard N. , et al. Opioid demand before and after anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (13) 3098-3103
  • 71 Beswick AD, Wylde V, Gooberman-Hill R. Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open 2015; 5 (05) e007387
  • 72 Scully RE, Schoenfeld AJ, Jiang W. , et al. Defining optimal length of opioid pain medication prescription after common surgical procedures. JAMA Surg 2018; 153 (01) 37-43
  • 73 Ballantyne JC. Opioid therapy in chronic pain. Phys Med Rehabil Clin N Am 2015; 26 (02) 201-218
  • 74 Lee JH. Anesthesia for ambulatory surgery. Korean J Anesthesiol 2017; 70 (04) 398-406