A team-based care approach comprised of the patient, family members, orthopedic surgeon, and other healthcare practitioners for total knee replacement procedures, combined with newer pain management strategies, is critical for maximizing patient outcomes. Findings from the literature review are published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). 

Calin S. Moucha, MD, the lead study author, stated that “managing post-surgical pain is key to promoting early postoperative mobility, reducing medication side effects, and increasing patient satisfaction.” Traditional pain management for total knee replacement procedures includes a patient-controlled analgesia (PCA) pump with or without epidural, which can cause nausea, vomiting, urinary retention, low blood pressure, constipation, and itching. 

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Newer multimodal pain management strategies have proved more effective in pain control with less side effects. These include a combination of pain management medications (eg, oral medications and nerve blocks) taken before and after surgery; regional anesthesia with pre-operative nerve blocks performed by an anesthesiologist; and intra-operative pain injections performed by the orthopedic surgeon within the knee.

The new method has found to lower patient pain severity ratings in the first few days post-surgery, minimize unwanted adverse events more commonly associated with traditional pain control protocols, lower the overall amount of narcotics needed for post-op pain control, and help patients better participate in early post-op physical therapy, and be more satisfied with post-op pain control.

Researchers added that patients should avoid long-term narcotic use for knee arthritis pain pre-surgery because the lower pain threshold that results may increase post-surgical pain. Patients should not abruptly discontinue oral medications due to the risk of rebound pain and development of chronic pain. Also, a support system of family and/or friends can benefit the patient in reaching the fastest recovery.

For more information visit journals.lww.com.