Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines

Abstract

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty.

Keywords: Analgesics; Pain control; Total hip arthroplasty.

Fig. 1. Spinothalamic tract. Pain transmission from receptors in the skin ascends in the spinal cord to the postcentral gyrus via the lateral spinothalamic tract. First-order neurons transmit this sensory information and enter the spinal cord. Second-order neurons from the dorsal horn then decussate at the ventral commissure and ascend in the lateral spinothalamic tract before ending in the ventral posterolateral nuclei of the thalamus. Third-order neurons then project to the postcentral gyrus.