Multimodal pain management in TKA can reduce narcotics consumption, study shows: 3 insights

Discontinuing patient-controlled analgesia and femoral nerve blocks from multimodal total knee arthroscopy pain management protocols and adding liposomal bupivacaine resulted in fewer narcotics consumed and led to no difference in pain control and faster functional recovery, according to a study in Clinical Orthopaedics and Related Research.


Here are three things to know:

1. The authors retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1,808 patients who underwent primary TKA. Departmental pain management protocols were compared in six-month increments as the protocol changed. All patients received a multimodal pain management protocol including preoperative oral medications, spinal or general anesthesia, a short-acting intraoperative pericapsular injection and continued postoperative oral narcotics for breakthrough pain.

2. From September 2013 to April 2014, all patients received an intraoperative FNB and a PCA for the first 24 hours postoperatively. From May 2014 to October 2014, a periarticular injection of liposomal bupivacaine was added and FNBs were discontinued. After April 2015, PCA was eliminated. No other major changes were made to the TKA pain management protocol. Narcotic use, pain scores on eight-hour intervals, physical therapy milestones and discharge disposition were compared.

3. There were no differences in pain-related HCAHPS scores across all cohorts.

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