Best Multimodal Analgesic Protocol for Total Knee Arthroplasty

SUMMARY 

Total knee arthroplasty is one of the most commonly performed operations in the USA. As with any elective joint surgery, the primary goal includes functional restoration that is not limited by pain. The use of peripheral nerve blocks for patients undergoing knee arthroplasty has resulted in decreased pain scores, improved early ambulation and decreased time to achieve hospital discharge criteria. Concern has been raised over the potential risks of femoral nerve block, and there has been growing support for the adductor canal block. It is the author’s opinion that when not contraindicated, intraoperative neuraxial anesthesia combined with a continuous adductor canal block and a multimodal medication regimen for postoperative pain control is the best analgesic protocol for knee arthroplasty.

KEYWORDS :

• adductor canal block
• femoral nerve block
• local infiltration analgesia
• multimodal analgesia
• perineural infusion
• regional anesthesia
• total knee arthroplasty

Financial & competing interests disclosure

ER Mariano has received unrestricted educational program funding paid to his institution from the following companies: I-Flow/Kimberly-Clark (Lake Forest, CA, USA) and B Braun (Bethlehem, PA, USA). These companies had absolutely no input in the preparation of this manuscript. Dr. Mariano has received unrestricted educational program funding paid to his institution from I-Flow/Kimberly-Clark (Lake Forest, CA, USA) and B Braun (Bethlehem, PA, USA). These companies had no input into any aspect of the present study design and implementation; data collection, analysis and interpretation; or manuscript preparation. 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.

Additional information

Funding

ER Mariano has received unrestricted educational program funding paid to his institution from the following companies: I-Flow/Kimberly-Clark (Lake Forest, CA, USA) and B Braun (Bethlehem, PA, USA). These companies had absolutely no input in the preparation of this manuscript. Dr. Mariano has received unrestricted educational program funding paid to his institution from I-Flow/Kimberly-Clark (Lake Forest, CA, USA) and B Braun (Bethlehem, PA, USA). These companies had no input into any aspect of the present study design and implementation; data collection, analysis and interpretation; or manuscript preparation. 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.