Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Sep 1;103(17):1652-1662.
doi: 10.2106/JBJS.19.01423.

An Update on Multimodal Pain Management After Total Joint Arthroplasty

Joseph A Karam  1 , Eric S Schwenk  2 , Javad Parvizi  3
Affiliations
Review

An Update on Multimodal Pain Management After Total Joint Arthroplasty

Joseph A Karam et al. J Bone Joint Surg Am. .

Abstract

➤: Multimodal analgesia has become the standard of care for total joint arthroplasty as it provides superior analgesia with fewer side effects than opioid-only protocols.

➤: Systemic medications, including nonsteroidal anti-inflammatory drugs, acetaminophen, corticosteroids, and gabapentinoids, and local anesthetics via local infiltration analgesia and peripheral nerve blocks, are the foundation of multimodal analgesia in total joint arthroplasty.

➤: Ideally, multimodal analgesia should begin preoperatively and continue throughout the perioperative period and beyond discharge.

➤: There is insufficient evidence to support the routine use of intravenous acetaminophen or liposomal bupivacaine as part of multimodal analgesia protocols.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G595).

References

    1. Welchek CM, Mastrangelo L, Sinatra RS, Martinez R. Qualitative and quantitative assessment of pain. In: Sinatra RS, De Leon-Cassasola O, Viscusi ER, Ginsberg B, editors. Acute Pain Management. Cambridge University Press; 2009. p 147-171.
    1. Kehlet H, Werner M, Perkins F. Balanced analgesia: what is it and what are its advantages in postoperative pain? Drugs. 1999 Nov;58(5):793-7.
    1. Blanco C, Volkow ND. Management of opioid use disorder in the USA: present status and future directions. Lancet. 2019 Apr 27;393(10182):1760-72. Epub 2019 Mar 14.
    1. Murthy VH. Ending the Opioid Epidemic - A Call to Action. N Engl J Med. 2016 Dec 22;375(25):2413-5. Epub 2016 Nov 9.
    1. Hah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. Anesth Analg. 2017 Nov;125(5):1733-40.

MeSH terms