Analgesia following total knee arthroplasty

Purpose of review: Conventional methods of postoperative pain control for total knee arthroplasty include continuous epidural infusions of local anesthetic and patient-controlled intravenous narcotics. Dose-dependent side effects are common with these modalities and may result in limited effectiveness and decreased patient satisfaction. This review intends to detail recent advances in postoperative pain management after total knee arthroplasty. Recent findings: Multimodal, or balanced, techniques for postoperative pain control have been described that simultaneously utilize multiple analgesics with different mechanisms of action, additive effects and decreased dose-related side effects. Narcotic side-effect-sparing modalities include the scheduled use of acetaminophen, nonsteroidal anti-inflammatory drugs, tramadol, cryotherapy, and the use of sustained-release oral narcotics. In addition, regional nerve block is a reproducible technique that provides more consistent and efficacious analgesia than patient-controlled intravenous narcotic therapy alone and is associated with fewer side effects than continuous epidural analgesia. Summary: Regional nerve block coupled with nonnarcotic analgesics and combined long and short-acting oral narcotics decreases postoperative pain, allows for faster functional recovery, and decreases medication-related side effects. It may also shorten hospitalization and enhance patient satisfaction when compared with traditional approaches to postoperative pain management.