A Multimodal Analgesia Protocol for Total Knee Arthroplasty

Vendittoli, Pascal‐André; Makinen, Patrice; Drolet, Pierre; Lavigne, Martin; Fallaha, Michel; Guertin, Marie-Claude; Varin, F.

doi:10.2106/jbjs.e.00173

Cited by 337 publications

(310 citation statements)

References 29 publications

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“…There are some limitations to our study. First, we used the same protocol of multimodal analgesia for pain control in all patients [16,29]. However, we did not record morphine consumption or consider that in assessing pain.…”

Section: Discussionmentioning

confidence: 99%

Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA

Pongcharoen¹,

Yakampor²,

Charoencholvanish

2013

Clinical Orthopaedics &Amp; Related Research

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Background Since the medial parapatellar (MPP) approach in conventional TKA can cause patellar maltracking and anterior knee pain, some orthopaedic surgeons use the midvastus (MV) approach instead of the MPP approach to reduce patellar maltracking. Minimally invasive surgical (MIS) TKA has been developed to limit the damage to the surrounding muscle and reduce the necessity of patellar eversion during surgery. Thus, MIS TKA might be associated with proper patellar tracking and a low incidence of anterior knee pain. However, this presumption has not been confirmed. Questions/purposes We asked whether the incidence of patellar maltracking and anterior knee pain differed with the MV and MPP in association with MIS TKA. Methods We prospectively followed 59 patients (60 knees)

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Section: Discussionmentioning

confidence: 99%

Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA

Pongcharoen¹,

Yakampor²,

Charoencholvanish

2013

Clinical Orthopaedics &Amp; Related Research

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“…Except for the study by Badner et al [3], studies using intraarticular injections alone failed to show a reduction of narcotic consumption after surgery [5,16,19,22]. Comparing PAI with narcotics alone, two studies [17,27] found decreased early postoperative pain and morphine consumption (Table 4). Comparing PAI with continuous femoral nerve block, Toftdahl et al [26] reported lower pain and morphine consumption in the PAI group on the first day postsurgery.…”

Section: Discussionmentioning

confidence: 99%

“…An estimated sample size of 27 in each group was needed to provide 80% power to detect a clinically meaningful difference of 15 mg morphine consumption from PCA during the first 48 hours [27] between the two groups with a SD of 19.4 mg and alpha error of 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…In a previous randomized controlled trial (RCT) evaluating PAI, we showed that mean morphine consumption was lower in the PAI group than the control group up to 40 hours postoperatively (46.7 mg compared with 68.6 mg, respectively) [27]. Other authors compared different PAI protocols versus femoral nerve block and have reported lower pain scores and consumption of opioids in their PAI group [21,26].…”

Section: Introductionmentioning

confidence: 93%

“…Furthermore, it should maintain maximum muscle control to optimize postoperative rehabilitation and inhibit venous stasis. Periarticular anesthetic infiltration (PAI) reportedly achieves these goals [27].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. Questions/purposes We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. Methods We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

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Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Chan

Fransen

Parker

et al. 2012

Cochrane Database of Systematic Reviews

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A Multimodal Analgesia Protocol for Total Knee Arthroplasty

Abstract: This multimodal perioperative analgesia protocol that included infiltration of a local anesthetic offered improved pain control and minimal side effects to patients undergoing total knee arthroplasty. Our study also confirmed the safety of the protocol.

Cited by 337 publications

References 29 publications

Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA

Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Femoral nerve blocks for acute postoperative pain after knee replacement surgery

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