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01-02-2019 | OPIOID PRESCRIBING AND PAIN MANAGEMENT / COMMENTARY

Opioid-Free Total Knee Arthroplasty? Local Infiltration Analgesia Plus Multimodal Blood-Loss Prevention Make it Possible

Authors: E. Carlos Rodriguez-Merchan, MD, PhD, Alfonso Vaquero-Picado, MD, FEBOT, Juan S. Ruiz-Perez, MD

Published in: HSS Journal ® | Issue 1/2019

Abstract

Opioids have been widely used in the USA for pain control after total knee arthroplasty (TKA). However, adverse effects, especially the possibility of addiction, have increased interest in opioid-free pain management after surgery. We therefore sought to review current pain management protocols after TKA, focusing especially on opioid-free alternatives. We reviewed the literature on pain management after TKA using Medline (PubMed), through June 30, 2018, using the keywords “TKA” and “analgesia.” We found 388 articles but chose to analyze the 34 that presented high-quality (levels I and II) evidence. Local infiltration analgesia (LIA) is a good option for reducing the use of post-operative opioids; many reports have compared LIA against a nerve block or studied the synergies between two protocols of loco-regional anesthesia. Multimodal blood-loss prevention is sometimes recommended in combination with opioid-free analgesia. In most studies, however, no differences are reported or contradictory results exist. Post-operative pain management protocols vary so much that it is difficult to strongly favor a determined pathway.

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Title: Opioid-Free Total Knee Arthroplasty? Local Infiltration Analgesia Plus Multimodal Blood-Loss Prevention Make it Possible
Authors: E. Carlos Rodriguez-Merchan, MD, PhD
Alfonso Vaquero-Picado, MD, FEBOT
Juan S. Ruiz-Perez, MD
Publication date: 01-02-2019
Publisher: Springer US
Published in: HSS Journal ® / Issue 1/2019
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-018-9636-2

At a glance: The STEP trials

Springer Medicine

Opioid-Free Total Knee Arthroplasty? Local Infiltration Analgesia Plus Multimodal Blood-Loss Prevention Make it Possible

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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