Acute Pain Management in Total Knee Arthroplasty

A significant proportion of patients receiving a total knee arthroplasty report inadequate postoperative pain control. Postoperative pain gives rise to adverse physiological and psychological responses with a detrimental effect on patient outcomes and satisfaction. Rehabilitation is delayed with increases in the length of hospital stay and healthcare costs. Recent advances in this field focus on a multimodal analgesic regime that combines a number of approaches to provide more effective pain management. Detailed preoperative assessment allows a multidisciplinary team to identify and address factors that increase the risk of severe or difficult to manage postoperative pain. There may also be a role for ‘pre-emptive’ analgesia administered prior to the procedure. Intraoperatively, spinal or general anaesthesia can be supplemented with nerve blocks and local infiltrative anaesthesia. Postoperatively, combining different classes of drug and delivery techniques provides effective analgesia while reducing the reliance on opiates and their adverse effects that can delay recovery. At present, the heterogeneity of different analgesic approaches limits the interpretation of many clinical studies. The development of standardised patient-specific analgesic regimes will aid future research.