Updates on Multimodal Analgesia for Orthopedic Surgery

Anesthesiol Clin. 2018 Sep;36(3):361-373. doi: 10.1016/j.anclin.2018.05.001. Epub 2018 Jul 11.


Pain control after orthopedic surgery is challenging. A multimodal approach provides superior analgesia with fewer side effects compared with opioids alone. This approach is particularly useful in light of the current opioid epidemic in the United States. Several new nonopioid agents have emerged into the market in recent years. New agents included in this review are intravenous acetaminophen, intranasal ketorolac, and newer nonsteroidal anti-inflammatory drugs, and the established medications ketamine and gabapentinoids. This article evaluates the evidence supporting these drugs in a multimodal context, including a brief discussion of cost.

Keywords: Acetaminophen; Celecoxib; Gabapentinoids; Ibuprofen; Ketamine; Ketorolac; Multimodal analgesia; Orthopedic surgery.

Publication types

  • Review

MeSH terms

  • Acetaminophen / therapeutic use
  • Amines / therapeutic use
  • Analgesia / methods*
  • Celecoxib / therapeutic use
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Gabapentin
  • Humans
  • Ibuprofen / therapeutic use
  • Ketamine / therapeutic use
  • Ketorolac / therapeutic use
  • Orthopedic Procedures / methods*
  • Pain, Postoperative / drug therapy*
  • gamma-Aminobutyric Acid / therapeutic use


  • Amines
  • Cyclohexanecarboxylic Acids
  • Acetaminophen
  • gamma-Aminobutyric Acid
  • Ketamine
  • Gabapentin
  • Celecoxib
  • Ibuprofen
  • Ketorolac