Anesthesia and Analgesia Practices in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership

Abstract

Background: The purpose of this study is to survey the current analgesia and anesthesia practices used by total joint arthroplasty surgeon members of the American Association of Hip and Knee Surgeons (AAHKS).

Methods: A survey of 28 questions was created and approved by the AAHKS Research Committee. The survey was distributed to all 2208 board-certified adult reconstruction surgeon members of AAHKS in November 2018.

Results: There were 622 responses (28.2%) to the survey. A majority of respondents (93.2%, n = 576) use preemptive analgesia prior to total joint arthroplasty. Most respondents use a spinal for total knee arthroplasty (TKA) (74.4%) and total hip arthroplasty (THA) (72.6%). A peripheral nerve block is routinely used by 68.7% of respondents in primary TKA. Periarticular injection or local infiltration anesthesia is routinely used by 80.3% of respondents for both TKA and THA patients. The average number of opioid pills prescribed postoperatively after TKA is 49 pills (range 0-200) and after THA is 44 pills (range 0-200). Most surgeons (58%) expect that this prescription should last for 2 weeks. A majority of respondents (74.0%) use multimodal analgesics in addition to opioids.

Conclusion: There is no consensus regarding the optimal multimodal anesthetic and analgesic regimen for total joint arthroplasty among surveyed board-certified arthroplasty surgeon members of AAHKS. Understanding current practice patterns in anesthesia, analgesia, and opioid prescribing may serve as a platform for future work aimed at establishing best clinical practices of maximizing effective postoperative pain control and minimizing the risks associated with prescribing opioids.

Keywords: anesthesia; multimodal analgesia; opioids; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty.