Pain management in total knee arthroplasty. A comprehensive review

Abstract

Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end-stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for the perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and urine retention, which limit their application in daily clinical practice. This review aimed to discuss the current postoperative pain management regimens for TKA. Our review of literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications, including preemptive analgesia, especially local infiltration analgesia and peripheral nerve blockade. Multimodal analgesia provides superior pain relief, promotes knee recovery, and reduces opioid consumption and related adverse effects in patients undergoing TKA.