An Update on Multimodal Pain Management After Total Joint Arthroplasty

J Bone Joint Surg Am. 2021 Sep 1;103(17):1652-1662. doi: 10.2106/JBJS.19.01423.

Abstract

➤: Multimodal analgesia has become the standard of care for total joint arthroplasty as it provides superior analgesia with fewer side effects than opioid-only protocols.

➤: Systemic medications, including nonsteroidal anti-inflammatory drugs, acetaminophen, corticosteroids, and gabapentinoids, and local anesthetics via local infiltration analgesia and peripheral nerve blocks, are the foundation of multimodal analgesia in total joint arthroplasty.

➤: Ideally, multimodal analgesia should begin preoperatively and continue throughout the perioperative period and beyond discharge.

➤: There is insufficient evidence to support the routine use of intravenous acetaminophen or liposomal bupivacaine as part of multimodal analgesia protocols.

Publication types

  • Review

MeSH terms

  • Acetaminophen / therapeutic use
  • Adrenal Cortex Hormones / therapeutic use
  • Analgesia / methods*
  • Analgesics, Non-Narcotic / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Anesthetics, Local / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthroplasty, Replacement / adverse effects*
  • Bupivacaine / therapeutic use
  • Gabapentin / analogs & derivatives
  • Humans
  • Nerve Block / methods
  • Pain Management / methods*
  • Pain, Postoperative / therapy*
  • Tramadol / therapeutic use

Substances

  • Adrenal Cortex Hormones
  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Anesthetics, Local
  • Anti-Inflammatory Agents, Non-Steroidal
  • Acetaminophen
  • Tramadol
  • Gabapentin
  • Bupivacaine