Controlling Pain After Total Hip And Knee Arthroplasty Using a Multimodal Protocol With Local Periarticular Injections: A Prospective, Randomized Study

Parvataneni, Hari K.; Shah, Vineet; Ranawat, Amar S.; Weiskopf, Joanne; Howard, Holly; Cole, Naida M.; Ranawat, Chitranjan S.

doi:10.1016/j.arth.2006.12.027

Cited by 99 publications

(173 citation statements)

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“…Currently, our practice has evolved to using a multimodal protocol which emphasizes local, periarticular injections, while minimizing the use of parenteral narcotics (Table 1) [22,23]. Patients who undergo joint replacement often have unrealistic preoperative expectations of recovery, including those for pain and function, which may lead to high levels of dissatisfaction [10,20].…”

Section: Our Experience With Multimodal Pain Protocolsmentioning

confidence: 99%

“…The steroid prevents local inflammation, and morphine stimulates all three opiate receptors (l, ð, and k) in the joint with less adverse systemic effects [18,19,22,23,33,34]. Epinephrine prolongs the action of local agents by decreasing absorption by vasoconstriction via its a-adrenergic effect.…”

Section: Intraoperative Periarticular Injectionmentioning

confidence: 99%

“…Epinephrine prolongs the action of local agents by decreasing absorption by vasoconstriction via its a-adrenergic effect. We consider these injections the most important and effective component of this pain protocol [22,23]. Clonidine exerts its effect via its a-2 adrenergic actions and results in potentiation of the synergistic action of local anesthetic and local steroids [16].…”

Section: Intraoperative Periarticular Injectionmentioning

confidence: 99%

“…Between October 2005 and October 2006, we enrolled 36 patients undergoing THA along with 35 controls and 31 patients undergoing TKA and 29 controls were enrolled in a prospective randomized study with or without a periarticular injection [22,23]. Patients in the hip study group had lower pain scores and better satisfaction scores (both with p \ 0.05) on each day of hospitalization.…”

Section: Intraoperative Periarticular Injectionmentioning

confidence: 99%

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Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Maheshwari

Blum

Shekhar

et al. 2009

Clin Orthop Relat Res

287

160

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Improvements in pain management techniques in the last decade have had a major impact on the practice of total hip and knee arthroplasty (THA and TKA). Although there are a number of treatment options for postoperative pain, a gold standard has not been established. However, there appears to be a shift towards multimodal approaches using regional anesthesia to minimize narcotic consumption and to avoid narcotic-related side effects. Over the last 10 years, we have used intravenous patient-controlled analgesia (PCA), femoral nerve block (FNB), and continuous epidural infusions for 24 and 48 hours with and without FNB. Unfortunately, all of these techniques had shortcomings, not the least of which was suboptimal pain control and unwanted side effects. Our practice has currently evolved to using a multimodal protocol that emphasizes local periarticular injections while minimizing the use of parenteral narcotics. Multimodal protocols after THA and TKA have been a substantial advance; they provide better pain control and patient satisfaction, lower overall narcotic consumption, reduce hospital stay, and improve function while minimizing complications. Although no pain protocol is ideal, it is clear that patients should have optimum pain control after TKA and THA for enhanced satisfaction and function. Level of Evidence: Level V, expert opinion. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Our Experience With Multimodal Pain Protocolsmentioning

confidence: 99%

Section: Intraoperative Periarticular Injectionmentioning

confidence: 99%

Section: Intraoperative Periarticular Injectionmentioning

confidence: 99%

Section: Intraoperative Periarticular Injectionmentioning

confidence: 99%

See 2 more Smart Citations

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Maheshwari

Blum

Shekhar

et al. 2009

Clin Orthop Relat Res

287

160

View full text Add to dashboard Cite

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“…However, the authors concluded that due to fewer systemic side effects the use of cFNB was superior [59]. Parvataneni et al [44] in a prospective randomized study compared local periarticular injections with PCA on THA patients. They had 35 patients in the study group and 36 patients in the control group.…”

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and welldesigned prospective randomized studies with outcome measures are necessary to confirm its efficacy.

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Extended Release Local Anesthetic Agents in a Postoperative Arthritic Pain Model

Ickowicz

Golovanevski

Haze

et al. 2014

Journal of Pharmaceutical Sciences

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Controlling Pain After Total Hip And Knee Arthroplasty Using a Multimodal Protocol With Local Periarticular Injections: A Prospective, Randomized Study

Cited by 99 publications

References 0 publications

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Extended Release Local Anesthetic Agents in a Postoperative Arthritic Pain Model

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