Pain management after total knee arthroplasty

Lavand’homme, Patricia; Kehlet, Henrik; Rawal, Narinder; Joshi, Girish P.

doi:10.1097/eja.0000000000001691

Cited by 104 publications

(90 citation statements)

References 239 publications

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“…In TKA this recommendation is based on an equal or potentially greater analgesic effects, particularly on dynamic pain, compared with LIA alone. 13 However, the combination of ACB and LIA was only found to provide superior pain control during the initial 24 h and with no opioid sparing effect compared with by itself LIA. 13 …”

Section: Discussionmentioning

confidence: 97%

“… 13 However, the combination of ACB and LIA was only found to provide superior pain control during the initial 24 h and with no opioid sparing effect compared with by itself LIA. 13 …”

Section: Discussionmentioning

confidence: 97%

“…The use of peripheral nerve blocks (PNB) has been much debated due to the analgesic effects resulting in reduced opioid consumption and improved patient satisfaction, 5 but also because of potential reductions in LOS 6 , 7 , 8 and various postoperative complications 5 such as wound infections in TKA and pulmonary complications in THA. 6 Subsequently, routine use of PNB has been recommended in several 9 , 10 , 11 , 12 , 13 but not all recent guidelines. 14 …”

Section: Introductionmentioning

confidence: 99%

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Peripheral nerve‐blocks and associations with length of stay and readmissions in fast‐track total hip and knee arthroplasty

Jørgensen

Petersen

Daugberg

et al. 2022

Acta Anaesthesiol Scand

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Background: Peripheral nerve blocks (PNB) have recently been recommended in total hip (THA) and knee (TKA) arthroplasty as they may reduce pain, morphine consumption, length of stay (LOS) and complications. However, whether PNBs are associated with early discharge within an enhanced recovery protocol including multimodal analgesia is uncertain.Methods: An observational multicenter study from January to August 2017 in six Danish Arthroplasty Centers with established fast-track protocols. Prospective recording of preoperative characteristics and information on PNB, LOS and readmissions through the Danish National Patient Registry and medical records. Multiple logistic regression was used to investigate associations between PNB and a LOS >1 day, LOS >4 days, and 30-days readmissions. We also reported on mobilization, pain, opioid and fall-related complications leading to LOS >4 days or readmissions.Results: A total of 2027 (58.6%) THA and 1432 (41.4%) TKAs with a median LOS of 1 day (IQR 1-2) and 5.3% (CI:4.6-6.1) 30-days readmission rate were identified. PNB was used in 40.7% (CI:38.2-43.3) of TKA and 2.7% (CI:2.0-3.5) of THA, but with considerable interdepartmental variation (0.0-89.0% for TKA). There was no associa-

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Section: Discussionmentioning

confidence: 97%

“… 13 However, the combination of ACB and LIA was only found to provide superior pain control during the initial 24 h and with no opioid sparing effect compared with by itself LIA. 13 …”

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Peripheral nerve‐blocks and associations with length of stay and readmissions in fast‐track total hip and knee arthroplasty

Jørgensen

Petersen

Daugberg

et al. 2022

Acta Anaesthesiol Scand

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“…Per institutional protocol, 1 g intravenous paracetamol, 20 mg.kg −1 tranexamic acid (given in two separate doses before and after tourniquet release) and 24 mg intravenous dexamethasone were administered. The latter, which has been related to better pain control and reduced opioid consumption in total knee arthroplasty, has been incorporated as an essential constituent of our analgesic protocol [14].…”

Section: Methodsmentioning

confidence: 99%

Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

et al. 2022

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Genicular nerves block is a promising technique to treat acute postoperative pain in total knee arthroplasty. Similar to surgeon-administered local infiltration analgesia, it targets sensory branches from the knee capsule, but through a selective ultrasound-guided injection that reduces local anaesthetic dose (150 ml ropivacaine 0.2% with local infiltration analgesia vs. 20 ml with genicular nerves block). This randomised non-inferiority trial compared the analgesic efficacy of genicular nerves block vs. local infiltration analgesia in the first 24 h following total knee arthroplasty. Sixty patients were randomly allocated to receive either ultrasound-guided block of five genicular nerves or local infiltration analgesia. The primary outcome was rest pain numeric rating scale (0-10) at 24 h. Secondary outcomes included pain numeric rating scale (rest and movement) and cumulative opioid consumption during the first 24 h. We analysed 29 patients in the genicular nerves block group and 30 in the local infiltration analgesia group. We found that the median difference (95%CI) in postoperative rest pain at 24 h (non-inferiority criteria, D = 1) was À1.0 (À2.0 to 1.0, p < 0.001). Median difference in cumulative opioid consumption was 0.0 mg (À3.0-5.0, p < 0.001) meeting the non-inferiority criteria, D = 23 mg. We conclude that genicular nerves block of five nerves provides non-inferior analgesia in the first 24 h following surgery compared with local infiltration analgesia, but with a considerable reduction in the local anaesthetic dose.

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“…Opioids of any kind are used only as rescue treatment and opioids with depository effect are not used routinely. Medication with paracetamol and NSAIDs is initiated 1–2 hours preoperatively as premedication ( 28 , 29 ). Furthermore, antiemetics and laxative treatment are provided postoperatively for rescue use.…”

Section: Study Protocolmentioning

confidence: 99%

Study protocol for discharge on day of surgery after hip and knee arthroplasty from the Center for Fast-track Hip and Knee Replacement

Lindberg‐Larsen

Varnum

Jakobsen

et al. 2023

ActaO

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Background and purpose: Limited data exists on the implementation process and safety of discharge on the day of surgery after primary hip and knee arthroplasty in a multicenter setting. We report our study protocol on the investigation of the feasibility, safety, and socioeconomic aspects following discharge on day of surgery after hip and knee arthroplasty across 8 fast-track centers.Patients and methods: This is a study protocol for a prospective cohort study on discharge on day of surgery from the Center for Fast-track Hip and Knee Replacement. The collaboration includes 8 centers covering 40% of the primary hip and knee arthroplasty procedures undertaken in Denmark. All patients scheduled for surgery are screened for eligibility using well-defined inclusion and exclusion criteria. Eligible patients fulfilling discharge criteria will be discharged on day of surgery. We expect to screen 9,000 patients annually.Duration and outcome: Patients will be enrolled over a 3-year period from September 2022 and reporting of results will run continuously until December 2025. We shall report the proportion of eligible patients and patients discharged on day of surgery as well as limiting factors. Readmissions and complications within 30 days are recorded with real-time follow-up by research staff. Furthermore, patient-reported information on willingness to repeat discharge on day of surgery, contacts with the healthcare system, complications, and workability is registered 30 days postoperatively. EQ-5D, Oxford Knee Score, and Oxford Hip Score are completed preoperatively and after 3 months and 1 year. Finally, outcome data will be used in the development of a prediction model for successful discharge on the day of surgery.

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Pain management after total knee arthroplasty

Cited by 104 publications

References 239 publications

Peripheral nerve‐blocks and associations with length of stay and readmissions in fast‐track total hip and knee arthroplasty

Peripheral nerve‐blocks and associations with length of stay and readmissions in fast‐track total hip and knee arthroplasty

Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

Study protocol for discharge on day of surgery after hip and knee arthroplasty from the Center for Fast-track Hip and Knee Replacement

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