Advances in perioperative pain management for total knee arthroplasty: a review of multimodal analgesic approaches

Abstract

Despite significant advancements in total knee arthroplasty (TKA), managing postoperative pain remains a substantial clinical challenge. With advances in surgical techniques and pharmacology, TKA perioperative analgesic strategies continue to evolve, necessitating ongoing reassessment of current data. Multimodal analgesia has become the standard for perioperative pain management in TKA; however, variations in its specific components and applications across studies create challenges in selecting the optimal analgesic approach. Evaluating these pain management strategies is essential for understanding their benefits, limitations, and appropriate use, allowing the development of individualized perioperative analgesic plans. This review aims to summarize current research on perioperative pain control in TKA and assess the effectiveness of different analgesic interventions.

Keywords: Multimodal analgesia; Pain; Perioperative; Total knee arthroplasty.

Fig. 1

Modulation of the pain pathway. Lines marked with a (−) sign indicate inhibitory effects, while lines with a ( +) sign represent stimulatory effects. NMDA, N-Methyl-D-Aspartate receptor antagonists; NSAIDs, nonsteroidal anti-inflammatory drugs. This figure highlights the critical importance of targeting multiple points along the pain signaling pathway to effectively manage pain