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HSS Journal ®
Erschienen in: HSS Journal ® 1/2019

07.12.2018 | OPIOID PRESCRIBING AND PAIN MANAGEMENT / REVIEW ARTICLE

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

verfasst von: Ellen M. Soffin, MD, PhD, Christopher L. Wu, MD

Erschienen in: HSS Journal ® | Ausgabe 1/2019

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Abstract

Background

Elective total joint arthroplasty may be a gateway to long-term opioid use.

Questions/Purpose

We 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).

Methods

We 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.

Results

Multimodal 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.

Conclusions

The 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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Metadaten
Titel
Regional and Multimodal Analgesia to Reduce Opioid Use After Total Joint Arthroplasty: A Narrative Review
verfasst von
Ellen M. Soffin, MD, PhD
Christopher L. Wu, MD
Publikationsdatum
07.12.2018
Verlag
Springer US
Erschienen in
HSS Journal ® / Ausgabe 1/2019
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-018-9652-2

Weitere Artikel der Ausgabe 1/2019

HSS Journal ® 1/2019 Zur Ausgabe

Opioid Prescribing and Pain Management / Original Article

Use of a Prescription Drug-Monitoring Program by Emergency and Surgical Prescribers: Results of a Hospital Survey

Opioid Prescribing and Pain Management / Commentary

Danger Close: What Opioid Prescribers Can Learn from the Way the Air Force Drops a Bomb

Opioid Prescribing and Pain Management / Consensus Statement

Consensus Statement: Toward Opioid-Free Arthroplasty: A Leadership Forum

Opioid Prescribing and Pain Management / Commentary

Opioid Prescribing and Physician Autonomy: A Quality of Care Perspective

Opioid Prescribing and Pain Management / Case Report

The Role of Peripheral Nerve Catheters in Buprenorphine/Naloxone Management in Elective Orthopedic Surgery: A Case Report

OPIOID PRESCRIBING AND PAIN MANAGEMENT / ORIGINAL ARTICLE

Institutional Guidelines Can Decrease the Amount of Opioids Prescribed After Total Joint Replacement

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