Up-to-date TKA pain management should include multimodal, opioid-sparing anesthesia
LISBON, Portugal —A sensible, simple approach to postoperative pain management in patients undergoing total knee arthroplasty typically involves as little morphine as possible and uses a combination of paracetamol and NSAIDs as a key defense against pain, according to an orthopedic surgeon from Hvidovre Hospital in Denmark.
During an Interactive Expert Exchange session at the EFORT Annual Congress, Kirill Gromov, MD, PhD, presented these and other strategies he finds effective for pain management in patients undergoing TKA.
“We have a variety of choices [on] how to treat those patients when anesthesia wears off. What we want to do is use as little morphine as possible to be able to ambulate the patients and to avoid side effects from morphine, that is postoperative nausea and vomiting,” he said.
Paracetamol and NSAIDs are good postoperative medications that Gromov said he and his colleagues have used for years.
“Steroids, I believe they are important,” Gromov said.
“What about [local infiltration anesthesia] LIA? This is probably the second most important thing when doing knee arthroplasty,” he said, mentioning a study he and his colleagues conducted that showed LIA was associated with a significant reduction in pain 24 hours after surgery.
Furthermore, LIA can provide a bonus saphenous nerve block effect, as well, he said.
Gromov prefers adductor canal blocks to femoral nerve blocks because it can be hard for patients to ambulate after TKA when they have received a femoral nerve block.
Postoperatively, he said he and his colleagues have abandoned the use of gabapentin.
In addition, cryotherapy had no effect after TKA compared to ice packs in a study by Emmanuel Thienpont, MD, MBA, PhD, Gromov said. However, “if you want to use some kind of cryotherapy in your patients, be sure to keep it as simple as possible.
“Multimodal opioid-sparing anesthesia is the gold standard right now for knee treatment,” he said. – by Susan M. Rapp
Gromov K. Pre- and peri-operative techniques to better control postoperative pain. Presented at: EFORT Annual Congress; June 5-7, 2019; Lisbon, Portugal.
Thienpont E. Clin Orthop Relat Res. 2014; doi:10.1007/s11999-014-3810-8.
Disclosure: Gromov reports no relevant financial disclosures.