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HSS Journal ®

, Volume 15, Issue 1, pp 17–19 | Cite as

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

  • E. Carlos Rodriguez-MerchanEmail author
  • Alfonso Vaquero-Picado
  • Juan S. Ruiz-Perez
OPIOID PRESCRIBING AND PAIN MANAGEMENT / COMMENTARY

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.

Keywords

knee total knee arthroplasty post-operative pain opioids local infiltration analgesia opioid-free TKA 

Notes

Compliance with Ethical Standards

Conflict of Interest: E. Carlos Rodriguez-Merchan, MD, PhD, Alfonso Vaquero-Picado, MD, FEBOT, and Juan S. Ruiz-Perez, MD, declare that they have no conflicts of interest.

Human/Animal Rights: N/A

Informed Consent: N/A 

Required Author Forms : Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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ESM 1 (PDF 1224 kb)

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Copyright information

© Hospital for Special Surgery 2018

Authors and Affiliations

  • E. Carlos Rodriguez-Merchan
    • 1
    Email author
  • Alfonso Vaquero-Picado
    • 1
  • Juan S. Ruiz-Perez
    • 1
  1. 1.Department of Orthopedic Surgery, Knee Surgery UnitLa Paz University Hospital—IdiPazMadridSpain

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