Pain Control in Total Knee Arthroplasty

Randa K. Elmallah; Morad Chughtai; Anton Khlopas; Jared M. Newman; Kim L. Stearns; Martin Roche; Michael A. Kelly; Steven F. Harwin; Michael A. Mont

doi:10.1055/s-0037-1604152

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2018; 31(06): 504-513
DOI: 10.1055/s-0037-1604152

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pain Control in Total Knee Arthroplasty

Authors

Randa K. Elmallah

¹Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
Morad Chughtai

²Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Anton Khlopas

²Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Jared M. Newman

²Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Kim L. Stearns

²Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Martin Roche

³Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
Michael A. Kelly

⁴Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey
Steven F. Harwin

⁵Department of Orthopaedic Surgery, Mount Sinai West, New York, New York
Michael A. Mont

²Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio

Abstract

As surgical techniques and pharmacology advance, the management of postoperative pain in patients undergoing total knee arthroplasty (TKA) continues to evolve. The current standards of care are composed of multimodal pain management including opioids, nonsteroidal anti-inflammatory drugs and gabapentinoids, peripheral nerve blocks, and periarticular injections. Newer modalities are composed of delayed release local anesthetics and cryoneurolysis. To summarize the current evidence-based treatment modalities and forecast changes in the management of patients having TKAs, we reviewed available data on: (1) oral analgesics; (2) periarticular injections; (3) peripheral nerve blocks; (4) multimodal regimens; and (5) newer modalities in post-TKA pain management. Multimodal analgesic regimens that target numerous pain pathways may provide the best pain management, rehabilitation, patient satisfaction, and reduce opioid use and related side effects. Periarticular injections of delayed-release local anesthetics may further enhance pain management.

Keywords

total knee arthroplasty - multimodal pain management - oral analgesics - periarticular injections - peripheral nerve blocks

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Referenzen

References
1 Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29 (02) 329-334
2 Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 2002; 10 (02) 117-129
3 Jiang J, Teng Y, Fan Z, Khan MS, Cui Z, Xia Y. The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J Arthroplasty 2013; 28 (10) 1882-1887
4 Musclow SL, Bowers T, Vo H, Glube M, Nguyen T. Long-acting morphine following hip or knee replacement: a randomized, double-blind, placebo-controlled trial. Pain Res Manag 2012; 17 (02) 83-88
5 Fan L, Zhu C, Zan P. , et al. The comparison of local infiltration analgesia with peripheral nerve block following total knee arthroplasty (TKA): a systematic review with meta-analysis. J Arthroplasty 2015; 30 (09) 1664-1671
6 Ma J, Zhang W, Yao S. Liposomal bupivacaine infiltration versus femoral nerve block for pain control in total knee arthroplasty: a systematic review and meta-analysis. Int J Surg 2016; 36 (Pt A): 44-55
7 Kirkness CS, Asche CV, Ren J. , et al. Assessment of liposome bupivacaine infiltration versus continuous femoral nerve block for postsurgical analgesia following total knee arthroplasty: a retrospective cohort study. Curr Med Res Opin 2016; 32 (10) 1-10
8 Hadzic A, Minkowitz HS, Melson TI. , et al. Liposome bupivacaine femoral nerve block for postsurgical analgesia after total knee arthroplasty. Anesthesiology 2016; 124 (06) 1372-1383
9 Chughtai M, Cherian JJ, Mistry JB, Elmallah RD, Bennett A, Mont MA. Liposomal bupivacaine suspension can reduce lengths of stay and improve discharge status of patients undergoing total knee arthroplasty. J Knee Surg 2016; 29 (03) 224-227
10 Cherian JJ, Muzaffar A, Barrington JW. , et al. Liposomal bupivacaine in total knee arthroplasty for better postoperative analgesic outcome and economic benefits. J Knee Surg 2016; 29 (03) 180-187
11 Barrington JW, Olugbode O, Lovald S, Ong K, Watson H, Emerson Jr RH. Liposomal bupivacaine: a comparative study of more than 1000 total joint arthroplasty cases. Orthop Clin North Am 2015; 46 (04) 469-477
12 Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anesth 2001; 13 (07) 524-539
13 Politi JR, Davis II RL, Matrka AK. Randomized prospective trial comparing the use of intravenous versus oral acetaminophen in total joint arthroplasty. J Arthroplasty 2017; 32 (04) 1125-1127
14 Seidenberg AB, An YH. Is there an inhibitory effect of COX-2 inhibitors on bone healing?. Pharmacol Res 2004; 50 (02) 151-156
15 Simon AM, Manigrasso MB, O'Connor JP. Cyclo-oxygenase 2 function is essential for bone fracture healing. J Bone Miner Res 2002; 17 (06) 963-976
16 Goodman S, Ma T, Trindade M. , et al. COX-2 selective NSAID decreases bone ingrowth in vivo. J Orthop Res 2002; 20 (06) 1164-1169
17 Jacobsson SA, Djerf K, Ivarsson I, Wahlström O. Effect of diclofenac on fixation of hydroxyapatite-coated implants. An experimental study. J Bone Joint Surg Br 1994; 76 (05) 831-833
18 Trappe TA, White F, Lambert CP, Cesar D, Hellerstein M, Evans WJ. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab 2002; 282 (03) E551-E556
19 Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol 2011; 24 (03) 331-338
20 Vadivelu N, Mitra S, Schermer E, Kodumudi V, Kaye AD, Urman RD. Preventive analgesia for postoperative pain control: a broader concept. Local Reg Anesth 2014; 7: 17-22
21 Moucha CS, Weiser MC, Levin EJ. Current strategies in anesthesia and analgesia for total knee arthroplasty. J Am Acad Orthop Surg 2016; 24 (02) 60-73
22 Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth 2016; 117 (Suppl. 03) iii62-iii72
23 Stowers MD, Manuopangai L, Hill AG, Gray JR, Coleman B, Munro JT. Enhanced recovery after surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg 2016; 86 (06) 475-479
24 Munteanu AM, Cionac Florescu S, Anastase DM, Stoica CI. Is there any analgesic benefit from preoperative vs. postoperative administration of etoricoxib in total knee arthroplasty under spinal anaesthesia? A randomised double-blind placebo-controlled trial. Eur J Anaesthesiol 2016; 33 (11) 840-845
25 Mallory TH, Lombardi Jr AVJ, Fada RA, Dodds KL, Adams JB. Pain management for joint arthroplasty: preemptive analgesia. J Arthroplasty 2002; 17 (04) (Suppl. 01) 129-133
26 Buvanendran A, Kroin JS, Della Valle CJ, Kari M, Moric M, Tuman KJ. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 2010; 110 (01) 199-207
27 Gong L, Dong J-Y, Li Z-R. Effects of combined application of muscle relaxants and celecoxib administration after total knee arthroplasty (TKA) on early recovery: a randomized, double-blind, controlled study. J Arthroplasty 2013; 28 (08) 1301-1305
28 Kazerooni R, Bounthavong M, Tran JN, Boggie DT, Meyer RS. Retrospective evaluation of inpatient celecoxib use after total hip and knee arthroplasty at a Veterans Affairs Medical Center. J Arthroplasty 2012; 27 (06) 1033-1040
29 Jain P, Jolly A, Bholla V, Adatia S, Sood J. Evaluation of efficacy of oral pregabalin in reducing postoperative pain in patients undergoing total knee arthroplasty. Indian J Orthop 2012; 46 (06) 646-652
30 Clarke HA, Katz J, McCartney CJ. , et al. Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block. Br J Anaesth 2014; 113 (05) 855-864
31 Hamilton TW, Strickland LH, Pandit HG. A meta-analysis on the use of gabapentinoids for the treatment of acute postoperative pain following total knee arthroplasty. J Bone Joint Surg Am 2016; 98 (16) 1340-1350
32 Ho K-Y, Tay W, Yeo M-C. , et al. Duloxetine reduces morphine requirements after knee replacement surgery. Br J Anaesth 2010; 105 (03) 371-376
33 Spangehl MJ, Clarke HD, Hentz JG, Misra L, Blocher JL, Seamans DP. The Chitranjan Ranawat Award: periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res 2015; 473 (01) 45-53
34 Kwofie MK, Shastri UD, Gadsden JC. , et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med 2013; 38 (04) 321-325
35 Elkassabany NM, Antosh S, Ahmed M. , et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg 2016; 122 (05) 1696-1703
36 Abdallah FW, Whelan DB, Chan VW. , et al. Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 2016; 124 (05) 1053-1064
37 Sporer SM, Rogers T. Postoperative pain management after primary total knee arthroplasty: the value of liposomal bupivacaine. J Arthroplasty 2016; 31 (11) 2603-2607
38 Motififard M, Omidian A, Badiei S. Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial. Int Orthop 2017; 41 (05) 939-947
39 Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplasty 2014; 29 (08) 1687-1690
40 Barrington JW, Emerson RH, Lovald ST, Lombardi AV, Berend KR. No difference in early analgesia between liposomal bupivacaine injection and intrathecal morphine after TKA. Clin Orthop Relat Res 2017; 475 (01) 94-105
41 Dysart S, Snyder MA, Mont MA. A randomized, multicenter, double-blind study of local infiltration analgesia with liposomal bupivacaine for postsurgical pain following total knee arthroplasty: rationale and design of the pillar trial. Surg Technol Int 2016; 30: 30
42 Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 2009; 467 (06) 1418-1423
43 Parvataneni HK, Ranawat AS, Ranawat CS. The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 2007; 56: 125-131
44 Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 2007; 22 (06) (Suppl. 02) 33-38
45 Busch CA, Shore BJ, Bhandari R. , et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006; 88 (05) 959-963
46 Kwon SK, Yang IH, Bai SJ, Han CD. Periarticular injection with corticosteroid has an additional pain management effect in total knee arthroplasty. Yonsei Med J 2014; 55 (02) 493-498
47 Teng Y, Jiang J, Chen S. , et al. Periarticular multimodal drug injection in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1949-1957
48 Bergese SD, Ramamoorthy S, Patou G, Bramlett K, Gorfine SR, Candiotti KA. Efficacy profile of liposome bupivacaine, a novel formulation of bupivacaine for postsurgical analgesia. J Pain Res 2012; 5: 107-116
49 Ranade VV. Drug delivery systems. 1. site-specific drug delivery using liposomes as carriers. J Clin Pharmacol 1989; 29 (08) 685-694
50 Bramlett K, Onel E, Viscusi ER, Jones K. A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty. Knee 2012; 19 (05) 530-536
51 Sakamoto B, Keiser S, Meldrum R, Harker G, Freese A. Efficacy of liposomal bupivacaine infiltration on the management of total knee arthroplasty. JAMA Surg 2017; 152 (01) 90-95
52 Dasta J, Ramamoorthy S, Patou G, Sinatra R. Bupivacaine liposome injectable suspension compared with bupivacaine HCl for the reduction of opioid burden in the postsurgical setting. Curr Med Res Opin 2012; 28 (10) 1609-1615
53 Jain RK, Porat MD, Klingenstein GG, Reid JJ, Post RE, Schoifet SD. The AAHKS Clinical Research Award: liposomal bupivacaine and periarticular injection are not superior to single-shot intra-articular injection for pain control in total knee arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 22-25
54 Alijanipour P, Tan TL, Matthews CN. , et al. Periarticular injection of liposomal bupivacaine offers no benefit over standard bupivacaine in total knee arthroplasty: a prospective, randomized, controlled trial. J Arthroplasty 2017; 32 (02) 628-634
55 Khlopas A, Elmallah RK, Chughtai M. , et al. The learning curve associated with the administration of intra-articular liposomal bupivacaine for total knee arthroplasty. a pilot study. Surg Technol Int 2017; 30: sti30/813
56 Nader A, Kendall MC, Manning DW. , et al. Single-dose adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia after total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med 2016; 41 (06) 678-684
57 Abdallah FW, Chan VW, Gandhi R, Koshkin A, Abbas S, Brull R. The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial. Anesthesiology 2014; 121 (06) 1302-1310
58 Jenstrup MT, Jæger P, Lund J. , et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 2012; 56 (03) 357-364
59 Paul JE, Arya A, Hurlburt L. , et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 2010; 113 (05) 1144-1162
60 Danninger T, Opperer M, Memtsoudis SG. Perioperative pain control after total knee arthroplasty: an evidence based review of the role of peripheral nerve blocks. World J Orthop 2014; 5 (03) 225-232
61 Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology 2013; 118 (02) 409-415
62 Duarte VM, Fallis WM, Slonowsky D, Kwarteng K, Yeung CK. Effectiveness of femoral nerve blockade for pain control after total knee arthroplasty. J Perianesth Nurs 2006; 21 (05) 311-316
63 Sakai N, Inoue T, Kunugiza Y, Tomita T, Mashimo T. Continuous femoral versus epidural block for attainment of 120° knee flexion after total knee arthroplasty: a randomized controlled trial. J Arthroplasty 2013; 28 (05) 807-814
64 Choi S, O'Hare T, Gollish J. , et al. Optimizing pain and rehabilitation after knee arthroplasty: a two-center, randomized trial. Anesth Analg 2016; 123 (05) 1316-1324
65 Chan EY, Fransen M, Sathappan S, Chua NH, Chan YH, Chua N. Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty 2013; 28 (04) 608-613
66 Al-Zahrani T, Doais KS, Aljassir F, Alshaygy I, Albishi W, Terkawi AS. Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty. J Arthroplasty 2015; 30 (01) 149-154
67 Hanson NA, Allen CJ, Hostetter LS. , et al. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg 2014; 118 (06) 1370-1377
68 Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty 2014; 29 (11) 2224-2229
69 Peters CL, Shirley B, Erickson J. The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty. J Arthroplasty 2006; 21 (06) (Suppl. 02) 132-138
70 Ranawat CS, Ranawat AS, Mehta A. Total knee arthroplasty rehabilitation protocol: what makes the difference?. J Arthroplasty 2003; 18 (03) (Suppl. 01) 27-30
71 Lavie LG, Fox MP, Dasa V. Overview of total knee arthroplasty and modern pain control strategies. Curr Pain Headache Rep 2016; 20 (11) 59
72 Wang Y, Klein MS, Mathis S, Fahim G. Adductor canal block with bupivacaine liposome versus ropivacaine pain ball for pain control in total knee arthroplasty: a retrospective cohort study. Ann Pharmacother 2016; 50 (03) 194-202
73 Vandepitte C, Kuroda M, Witvrouw R. , et al. Addition of liposome bupivacaine to bupivacaine HCl versus bupivacaine HCl alone for interscalene brachial plexus block in patients having major shoulder urgery. Reg Anesth Pain Med 2017; 42 (03) 334-341
74 Bellini M, Barbieri M. Percutaneous cryoanalgesia in pain management: a case-series. Anaesthesiol Intensive Ther 2015; 47 (04) 333-335
75 Barnard D. The effects of extreme cold on sensory nerves. Ann R Coll Surg Engl 1980; 62 (03) 180-187
76 Dasa V, Lensing G, Parsons M, Harris J, Volaufova J, Bliss R. Percutaneous freezing of sensory nerves prior to total knee arthroplasty. Knee 2016; 23 (03) 523-528
77 Khalil KG, Boutrous ML, Irani AD. , et al. Operative intercostal nerve blocks with long-acting bupivacaine liposome for pain control after thoracotomy. Ann Thorac Surg 2015; 100 (06) 2013-2018
78 Ilfeld BM, Viscusi ER, Hadzic A. , et al. Safety and side effect profile of liposome bupivacaine (Exparel) in peripheral nerve blocks. Reg Anesth Pain Med 2015; 40 (05) 572-582
79 Rice DC, Cata JP, Mena GE, Rodriguez-Restrepo A, Correa AM, Mehran RJ. Posterior intercostal nerve block with liposomal bupivacaine: an alternative to thoracic epidural analgesia. Ann Thorac Surg 2015; 99 (06) 1953-1960