Pain management after total knee arthroplasty: A prospective randomized study

Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review

OBJECTIVES

Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered.

METHODS

To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours.

RESULTS

Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine.

CONCLUSION

The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.

Reducing opioid usage in total knee arthroplasty postoperative pain management: a literature review and future directions

Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.

Acute Pain Management for Patients with Substance Use Disorder Receiving Buprenorphine or Methadone Compared to Patients without Opioid-Dependence Disorder

This single-center retrospective study assessed pain management between patients being treated for SUD and compared them to those without SUD who underwent orthopedic surgery. Patients with SUD could be admitted for any reason, while the control arm consisted of patients undergoing total knee arthroplasty or hip arthroplasty surgery. Primary endpoints were average pains scores and morphine milligram equivalents (MME) over the first 48h. Secondary endpoints include adjuvant pain medications and the average MME prescribed upon discharge. A total of the 60 patients were enrolled, 30 patients had history of SUD and 30 patients in the control arm. Average MME between the SUD and control was not significantly different (139.9 mg vs. 96.6 mg, p = 0.889). Average pain scores between the groups were significantly different (7.46 vs. 5.94, p = 0.002). Patients with SUD were not given a statistically different amount of MME for acute pain and experienced higher pain scores than patients without SUD. However, this study had a small population size, and further case-control studies are needed to confirm this result.