Management of Pain After Total Knee Arthroplasty

Total knee arthroplasty (TKA) is successful for the treatment of severe osteoarthritis of the knee. However, TKA patients often experience moderate to severe postoperative pain. In the perioperative period the type of anesthesia, the surgical approach, and the use of local anesthetics and analgesics affect postoperative pain management. Optimum pain management requires action at all stages of the TKA process and begins preoperatively with patient education. Preemptive analgesia is used to prevent the pathologic pain caused by incisional and inflammatory injury. Anesthesia is used to inhibit intraoperative neural impulses from reaching the central nervous system. The midvastus surgical approach has shown positive results in decreasing postoperative pain and in increasing functional outcome. Postoperative pain is potentially best managed with a multimodal approach that blocks pain perception at a variety of sites in the peripheral and central nervous systems. Treatment options include combinations of systemic analgesics and/or regional analgesia, with or without opioids. Multimodal pain management approaches have proven effective by reducing pain, narcotic usage, length of hospital stay, and the side effects associated with anesthesia and narcotic analgesics. Any pain management approach used should be the product of collaboration between physicians, nurses, pharmacists, and patients.