DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20213117

Postoperative analgesia in total knee arthroplasty

Rodrigo A. Mendoza-Aceves, Paola G. Gloria-Coronado, Enrique Ortega Madrid, Karen Meade Yovanovich, Mónica Padilla Zavala, Rodrigo Banegas-Ruiz, Francisco Fabian Gómez-Mendoza, Christian E. Soulé-Martínez, Baltazar Barrera-Mera, Alan I. Valderrama-Treviño

Abstract


Total knee arthroplasty is commonly performed in patients with end-stage osteoarthritis or rheumatic knee arthritis to relieve joint pain, increase mobility, and improve quality of life. Despite advances in surgical techniques, postoperative pain management in these types of patients is still deficient. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to total knee replacement and pain management. Pain after total knee arthroplasty has been shown to involve both peripheral and central pain pathways, which is why various postoperative pain management strategies are currently applied, including patient-controlled analgesia, continuous peripheral nerve blocks, or single injection or local infiltration analgesia. Today local techniques such as periarticular injections are becoming more common in total knee replacement due to their effectiveness in controlling pain without causing muscle weakness. The development of minimally invasive techniques associated with multimodal and preventive analgesia improves recovery rates and early rehabilitation in patients undergoing total knee arthroplasty, reducing in-hospital costs, risk of complications, and improving patient satisfaction with chronic osteoarthropathy.  


Keywords


Pain, Postoperative pain, Total knee arthroplasty, Pain control, Multimodal analgesia

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References


ShuYa Mei, ShuQing Jin, ZhiXia Chen, XiBing Ding, Xiang Zhao, Quan Li. Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block. 2015;70(9):648-53.

Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States-an alternative projection model. Osteoarthritis Cartilage. 2017;25(11):1797-803.

Aso K, Izumi M, Sugimura N. Additional benefit of local infiltration of analgesia to femoral nerve block in total knee arthroplasty: double-blind randomized control study. Knee Surg Sports Traumatol Arthrosc. 2019;27(7):2368-74.

Xu J, Chen XM, Ma CK, Wang XR. Peripheral nerve blocks for postoperative pain after major knee surgery. Cochrane Database of Systematic Reviews. 2014;(12):CD010937.

Srinivasa RN, Daniel CB, Milton C. La definición revisada de dolor de la Asociación Internacional para el Estudio del Dolor: conceptos, desafíos y compromisos. DOLOR. 2020;161:1976-82.

Li, Jing‐wen, Ma, Ye‐shuo, Xiao, Liang‐kun. Postoperative Pain Management in Total Knee Arthroplasty. Orthopaedic Surgery. 2019;11:755-61.

Hina N, Fletcher D, Poindessous ‐ Jazat F, Martinez V. Hiperalgesia inducida por el tratamiento con opioides en dosis bajas antes de la cirugía ortopédica: un estudio observacional de casos y controles. Eur J Anaesthesiol. 2015;32:255-61.

Trang T, Al-Hasani R, Salvemini D, Salter MW, Gutstein H, Cahill CM. Dolor y amapolas: lo bueno, lo malo y lo feo de los analgésicos opioides. J Neurosci. 2015;35:13879-88.

Weick J, Bawa H, Dirschl DR, Luu HH. El uso preoperatorio de opioides se asocia con mayores tasas de reingreso y revisión en artroplastia total de rodilla y cadera. J Bone Joint Surg Am. 2018;100:1171-6.

Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Park BY. Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty. Clin Orthop Surg. 2017;9:303-9.

Hina N, Fletcher D, Poindessous ‐ Jazat F, Martinez V. Hiperalgesia inducida por el tratamiento con opioides en dosis bajas antes de la cirugía ortopédica: un estudio observacional de casos y controles. Eur J Anaesthesiol. 2015;32:255-61.

Trang T, Al-Hasani R, Salvemini D, Salter MW, Gutstein H, Cahill CM. Dolor y amapolas: lo bueno, lo malo y lo feo de los analgésicos opioides. J Neurosci. 2015;35:13879-88.

Weick J, Bawa H, Dirschl DR, Luu HH. El uso preoperatorio de opioides se asocia con mayores tasas de reingreso y revisión en artroplastia total de rodilla y cadera. J Bone Joint Surg Am. 2018;100:1171-6.

Bian YY, Wang LC, Qian WW. Papel del parecoxib sódico en la analgesia multimodal después de la artroplastia total de rodilla: un ensayo controlado aleatorio doble ciego. Orthop Surg. 2018;10:321-7.

Jianda X, Yuxing Q, Yi G, Hong Z, Libo P, Jianning Z. Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study. Sci Rep. 2016;6:30354.

Lubis AMT, Rawung RBV, Tantri AR. Preemptive analgesia in total knee arthroplasty: comparing the effects of single dose combining celecoxib with pregabalin and repetition dose combining celecoxib with Pregabalin: double‐blind controlled clinical trial. Pain Res Treat. 2018;3807217.

Xu Z, Zhang H, Luo J, Zhou A, Zhang J. Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post‐operative pain of patients undergoing total knee arthroplasty. Phys Sportsmed. 2017;45:316-22.

Zamudio-Castilla LM, González Vera JF, Rodríguez-Conde JR, Dorado-Velasco FC. Implementación y evaluación de un protocolo de analgesia multimodal en el reemplazo total primario de rodilla que incluye bloqueo de canal de aductores guiado por ultrasonografía más infiltración de anestésico local periarticular. Revista de la Sociedad Española del Dolor. 2021;28(1):9-18.

Ilfeld BM, McCartney CJL. Searching for the Optimal Pain Management Technique after Knee Arthroplasty: Analgesia Is Just the Tip of the Iceberg. Anesthesiology. 2017;126:768-77

Lee GC. What's new in adult reconstructive knee surgery. J Bone Joint Surg Am. 2018;100(02):166-75.

Schneider J, Broome B, Keeley D. Narcotic-Free Perioperative Total Knee Arthroplasty: Does the Periarticular Injection Medication Make a Difference?. J Knee Surg. 2021;34(4):460-3.

Johnson RL, Kopp SL. Optimizing perioperative management of total joint arthroplasty. Anesthesiol Clin. 2014;32:865-80.