Reducing Opioid Usage in Total Knee Arthroplasty Postoperative Pain Management: A Literature Review and Future Directions

Abstract

Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.

Lay abstract

Total knee arthroplasty (TKA), also known as ‘knee replacement’, is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Historically, pain management after TKA has involved opioids, but in light of recent extensive opioid dependence and consumption, pain management plans that incorporate other non-opioid techniques should be considered. This study identifies the best practices for postoperative TKA pain management through a literature review of the last 3 years. Studies utilizing interventional techniques such as local analgesia and nerve blocks, as well as pharmacologic options (involving the administration of medicines), were reviewed on the following databases: PubMed, Embase, Ovid Medline and Scopus. The main outcomes analyzed were the effect of these different approaches on pain reduction, opioid use reduction and improvements in functional mobility or strength of the quadriceps muscle in the thigh following TKA surgery. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.

Keywords::

• cooled radiofrequency ablation (CRFA)
• local infiltrating analgesia (LIA)
• nerve block
• total knee arthroplasty (TKA)

Financial & competing interests disclosure

R Chakravarthy is a consultant to Abbott, Bioness, Medtronic, Nalu Medical, Saluda Medical. He has stock options in Nalu Medical. He is founder of Newrom Biomedical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.