Analgesia in Total Knee Arthroplasty

Abstract

➢ Implementation of multimodal pain management regimens after total knee arthroplasty has increased patient satisfaction, decreased pain scores, and facilitated faster recovery.➢ A variety of oral and intravenous analgesics, including nonsteroidal anti-inflammatory drugs, gabapentinoids, acetaminophen, and opioids, can be employed preoperatively and postoperatively.➢ Neuraxial anesthesia, peripheral nerve blocks, and periarticular injections are effective pain modulators that should be implemented in concert with the anesthesia teams.➢ There is no consensus on the optimal multimodal pain regimen, and substantial variability exists between institutions and providers.➢ The goals of minimizing pain and improving functional recovery in the postoperative period must be considered in light of evidence-based practice as well as the risk profile of the proposed analgesic treatment.

Adductor Canal Block vs Liposomal Bupivacaine Periarticular Injection in Total Knee Arthroplasty: A Randomized Controlled Trial

“…Knee range of motion was measured using a goniometer during office visits. Although liposomal bupivacaine has been shown to last only up to 72 hours [ 6 , 7 , 9 , 10 ], we included WOMAC and knee range of motion outcome data up to 8 weeks because early pain control has been shown to affect later functional outcomes [ [25] , [26] , [27] , [28] ]. Data were collected and recorded by the resident on the arthroplasty service, either in person if the patient was in hospital or by telephone if the patient was discharged.…”

Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl patch in management of postoperative pain after arthroscopic lower limb surgery: A randomized controlled trial

“…The durations of action for fentanyl and buprenorphine patches are different, approximately 3 and 7 days, respectively, and usually severity of postoperative pain is of moderate to severe grade in first 48–72 h only so we have decided to compare efficacy of fentanyl and buprenorphine patches and their side effects for 72 h postoperatively. [ 16 17 ] Keeping in mind the onset of action of opioid patch is 12–24 h, all the patients were given transdermal patch 12 h before surgery. We have used non opioid analgesic (diclofenac) in our study as rescue analgesics as adding intravenous or oral opioid with transdermal fentanyl or buprenorphine will further aggravate the side effects like nausea vomiting and respiratory depression related to opioids.…”

Total diz artroplastisi sonrası ağrı kontrolü ve rehabilitasyon

“…Ağrı kesici kullanırken hasta takibi düzenli yapılmalı ve ağrıyı oluşturabilecek intrinsik sebepler gözardı edilmemelidir. [7,8] Dizde enfeksiyon gelişme olasılığı özellikle cerrahiyi takip eden ilk bir yıl içinde daha yüksektir. Ayrıca protezde gevşeme, osteoliz ve aşınma da ilk bir yıl içinde ağrı sebepleri içinde öncelikli düşünülmelidir.…”

“…Multimodal analjezi ağrı yolunun farklı bölgelerine etki eden analjezik ajanların birlikte kullanımı ile sağlanmaktadır. [7,9] Diz protezinde multimodal analjezi ile ilgili çok sayıda çalışma vardır, ancak sonuçlar çelişkilidir. Belli bir algoritma oluşmamıştır.…”

“…Tüm bu faktörler hastanın erken fonksiyonel iyileşmesini etkileyebilir. [7,11,15] a-Femoral sinir bloğu: Femoral sinir blokajı diz protezini takiben analjezi için sık kullanılan bir yöntemdir. Ağrıyı kesmede etkili olmasına rağmen sık olarak cerrahi sonrasındaki günde kuadriseps zayıflığına bağlı mobilizasyonda güçlük ve düşme riskinde artış görülebilmektedir.…”