Postoperative Pain after Total Joint Arthroplasty: Pathophysiology and Current Pharmacological Pain Management

Abstract

This review is a literature review based on articles gathered over the previous 10 years from scientific search engines. To divide pain management following total joint arthroplasty into segments. The pain is frequently connected with incision pain induced by surgical damage to a major peripheral nerve and differs in quality and location from pain experienced before surgery. Acetaminophen, nonsteroidal anti-inflammatory drugs, and opioid analgesia are the three categories of medicines used to manage postsurgical pain. These medications can be used as pre-emptive analgesia or as part of a multimodal analgesia regimen. Multimodal analgesia is the most common therapy for postoperative pain following joint replacement. This medication is meant to lessen the risk of negative effects that may arise after taking opioids.

Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review

“…Recognizing this association, researchers have explored effective perioperative and postoperative pain management as a potential preventive strategy. Although multimodal analgesia is currently one of the primary methods for managing postoperative pain following these procedures [71], the incidence of CPSP after utilizing this therapeutic intervention has not yet been thoroughly examined clinically and necessitates additional study. This method utilizes predominantly nonopioid analgesics, aiming to achieve an additive or synergistic effect that enhances pain relief while concurrently diminishing opioid utilization and associated side effects [71,72].…”

“…Although multimodal analgesia is currently one of the primary methods for managing postoperative pain following these procedures [71], the incidence of CPSP after utilizing this therapeutic intervention has not yet been thoroughly examined clinically and necessitates additional study. This method utilizes predominantly nonopioid analgesics, aiming to achieve an additive or synergistic effect that enhances pain relief while concurrently diminishing opioid utilization and associated side effects [71,72]. The standard multimodal regimen begins in the preoperative phase, with the administration of a combination of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and a gabapentinoid [72].…”

“…This nuanced approach, in contrast to the historical preference for epidural analgesia, has garnered prominence due to documented limitations associated with the latter in orthopedic surgeries, such as TKA. Studies indicate that epidural analgesia is linked to prolonged postoperative recovery and a consequential "motor blockage" presenting as knee buckling, impairing subsequent ambulation [71].…”

“…Postoperative pain is associated with CPSP following TKA/THA [19,[22][23][24][25]. Multimodal analgesia is a leading strategy for reduction of postoperative pain [68,[71][72][73][74][75].…”

Manajemen Nyeri Distraksi Berbasis Virtual Reality (VR)

“…lebih lama, dan juga meningkatkan tingkat stres dan kecemasan bagi pasien dan keluarga (Jira et al, 2020;Soetjahjo et al, 2022;Yu et al, 2020).…”