Affordable Access

Access to the full text

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

Authors
  • Carlos Rodriguez-Merchan, E.1
  • Vaquero-Picado, Alfonso1
  • Ruiz-Perez, Juan S.1
  • 1 La Paz University Hospital—IdiPaz, Department of Orthopedic Surgery, Knee Surgery Unit, Paseo de la Castellana 261, Madrid, 28046, Spain , Madrid (Spain)
Type
Published Article
Journal
HSS Journal ®
Publisher
Springer US
Publication Date
Oct 15, 2018
Volume
15
Issue
1
Pages
17–19
Identifiers
DOI: 10.1007/s11420-018-9636-2
Source
Springer Nature
Keywords
License
Yellow

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 “TKA” and “analgesia.” 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.

Report this publication

Statistics

Seen <100 times