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Regional and Multimodal Analgesia to Reduce Opioid Use After Total Joint Arthroplasty: A Narrative Review

  • Soffin, Ellen M.1, 2
  • Wu, Christopher L.1, 2, 3
  • 1 Hospital for Special Surgery, Department of Anesthesiology, Critical Care and Pain Management, 535 East 70th St., New York, NY, 10021, USA , New York (United States)
  • 2 Weill Cornell Medical College and New York Presbyterian Hospital, Department of Anesthesiology, New York, NY, USA , New York (United States)
  • 3 Johns Hopkins University, Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA , Baltimore (United States)
Published Article
HSS Journal ®
Springer US
Publication Date
Dec 07, 2018
DOI: 10.1007/s11420-018-9652-2
Springer Nature


BackgroundElective total joint arthroplasty may be a gateway to long-term opioid use.Questions/PurposeWe sought to review the literature on multimodal and regional analgesia as a strategy to minimize perioperative opioid use and control pain in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA).MethodsWe conducted a narrative review to assess the state of the evidence informing opioid-sparing analgesics for THA and TKA. A PubMed search was conducted for English-language articles published before April 2018. We preferentially included well-designed randomized controlled trials, systematic reviews, and meta-analyses. Where the highest levels of evidence were not yet apparent, we evaluated retrospective and/or observational studies.ResultsMultimodal analgesia emphasizing nonsteroidal anti-inflammatory agents and acetaminophen is associated with decreases in perioperative opioid use for THA and TKA. Regional analgesia, including peripheral nerve blocks and local infiltration analgesia, is also associated with decreased perioperative opioid use for THA and TKA. Emerging topics in post-arthroplasty analgesia include (1) the value of nonsteroidal anti-inflammatory drugs, (2) the use of peripheral nerve catheters and extended-release local anesthetics to prolong the duration of opioid-free analgesia, and (3) novel peripheral nerve blocks, exemplified by the IPACK (interspace between the popliteal artery and posterior capsule of the knee) block for TKA.ConclusionsThe use of multimodal analgesia with regional techniques may decrease perioperative opioid use for patients undergoing THA and TKA. These techniques should be part of a comprehensive perioperative plan to promote adequate analgesia while minimizing overall opioid exposure.

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