Opioid-Free Total Knee Arthroplasty? Local Infiltration Analgesia Plus Multimodal Blood-Loss Prevention Make it Possible

Abstract

Opioids have been widely used in the USA for pain control after total knee arthroplasty (TKA). However, adverse effects, especially the possibility of addiction, have increased interest in opioid-free pain management after surgery. We therefore sought to review current pain management protocols after TKA, focusing especially on opioid-free alternatives. We reviewed the literature on pain management after TKA using Medline (PubMed), through June 30, 2018, using the keywords BTKA^and Banalgesia.^We found 388 articles but chose to analyze the 34 that presented high-quality (levels I and II) evidence. Local infiltration analgesia (LIA) is a good option for reducing the use of post-operative opioids; many reports have compared LIA against a nerve block or studied the synergies between two protocols of loco-regional anesthesia. Multimodal blood-loss prevention is sometimes recommended in combination with opioid-free analgesia. In most studies, however, no differences are reported or contradictory results exist. Post-operative pain management protocols vary so much that it is difficult to strongly favor a determined pathway. Keywords knee. total knee arthroplasty. post-operative pain. opioids. local infiltration analgesia. opioid-free TKA

The use of燨pioids爄n燭otal Knee Arthroplasty燩atient: Main Characteristics, Risk燜actors and Adverse Events

“…Rodriguez-Merchan et al have recently published that local infiltration analgesia (LIA) is a good option for reducing the use of postoperative opioids. Multimodal blood-loss prevention was recommended in combination with opioid-free analgesia [20] .…”

Total Knee Arthroplasty With and Without Schedule II Opioids: A Randomized, Double-Blinded, Placebo-Controlled Trial

“…Multimodal pain regimens have gained popularity in recent years in an effort to improve postoperative pain control while simultaneously reducing reliance on opioid medications [14][15][16][17][18]. These regimens utilize local anesthetics, peripheral nerve blocks, and non-narcotic alternatives for effective pain control.…”

Comparison of adductor canal block with periarticular infiltration analgesia in total knee arthroplasty

“…[6,7] Several techniques had been used for postoperative pain relief, such as intravenous opioids, peripheral nerve block, epidural analgesia, adductor block, femoral nerve block (FNB), and periarticular infiltration analgesia (PIA). [7][8][9][10] While it has been reported that implementing FNB with a risk of injuring the nerve, influencing quadriceps function, as well as benefiting the area of the femoral nerve only. [11] The PIA has been used over the last decade for postoperative analgesia following TKA.…”