Elsevier

The Journal of Arthroplasty

Volume 29, Issue 2, February 2014, Pages 329-334
The Journal of Arthroplasty

Multimodal Pain Management in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

https://doi.org/10.1016/j.arth.2013.06.005Get rights and content

Abstract

We analyze the effects of a multimodal analgesic regimen on postoperative pain, function, adverse effects and satisfaction compared to patient-controlled analgesia (PCA). Thirty-six patients undergoing TKA were randomized to receive either (1) periarticular injection before wound closure (30 cc 0.5% bupivacaine, 10 mg MSO4, 15 mg ketorolac) and multimodal analgesics (oxycodone, tramadol, ketorolac; narcotics as needed) or (2) hydromorphone PCA. Preoperative and postoperative data were collected for VAS pain scores, time to physical therapy milestones, hospital stay length, patient satisfaction, narcotic consumption and medication-related adverse effects. The multimodal group had lower VAS scores, fewer adverse effects, lower narcotic usage, higher satisfaction scores and earlier times to physical therapy milestones. Multimodal pain management protocol decreases narcotic usage, improves pain scores, increases satisfaction and enhances early recovery.

Section snippets

Patients and Randomization

We performed a randomized controlled trial of patients undergoing minimally invasive primary total knee arthroplasty at a single institution. For our purposes, minimally invasive indicates the use of custom-modified instrumentation, a quadriceps sparing arthrotomy that does not extend beyond 1 cm proximal to the patella and surgical techniques that focus on soft tissue protection. Inclusion criterion were patients desiring rapid rehab and early discharge with tricompartmental knee disease

Results

From January 2010 until April, 2010, 36 patients, of an eligible 55 were randomized into one of two groups, with 19 assigned to the multimodal group and 17 to the PCA group. No patient was lost to follow-up. Demographic data did not significantly differ between the two groups (Table 3). There were no significant differences in intraoperative anesthesia administered between the groups, and the type of anesthesia had no significant impact on pain scores or physical therapy milestones. At the

Discussion

Total knee arthroplasty is one of the most successful medical procedures, but a critical consideration in total knee arthroplasty recovery remains postoperative pain control. Adequate pain control allows faster rehabilitation, reduces complications and is correlated with patient satisfaction 12., 39., 40., 41.. Additionally, pain control has been shown as the most important component of patient satisfaction 12., 39., 42.. Before recent perioperative pain management advances, 60%–90% of patients

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.06.005.

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    These authors contributed equally to this work.

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