Perioperative Pain Management in Total Knee Arthroplasty: A Narrative Review of Current Multimodal Analgesia Protocols

Abstract

Since there is no consensus on the optimal perioperative analgesic method, the present article provides a brief and practical synthesis on current multimodal pre–postsurgery analgesia protocols for primary TKA (excluding intraoperative anesthetic techniques) reported especially in recent meta-analyses and reviews. The focus is not only on the traditional aims (pain scores and opioid sparing), but also the functional recovery and patient-reported outcomes. Multimodal analgesia (pre-emptive analgesia, local infiltration analgesia, peripheral nerve blocks, and specific systemic drugs) is considered the optimal regimen for perioperative pain management of TKA.

Cruciate-Retaining Total Knee Arthroplasty versus Unicompartmental Knee Arthroplasty in Medial Compartmental Osteoarthritis: A Propensity Score-Matched Analysis of Early Postoperative Recovery

“…Currently, multiple analgesic pathways consisting of pre-emptive analgesia, peripheral nerve block, periarticular anesthetic infiltration, and specific systemic medication are principles that enhance recovery after surgery. 21 Our multimodal pain regimen for TKA, which comprises PAI with bupivacaine and ketorolac, pre-emptive ACB, and intra-articular tranexamic acid, was developed based on the results of our previous studies to mitigate post-TKA pain. 22,23 Nonetheless, in the present study, the UKA group still had a significantly better knee flexion angle and SLR and could independently ambulate earlier than the CR TKA group during the acute postoperative phase.…”