An Update on Multimodal Pain Management After Total Joint Arthroplasty.

J Bone Joint Surg Am · Sep 01 2021 · Review

Karam JA, Schwenk ES, Parvizi J

Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania

Adult Reconstruction

SUMMARY — THE REDUCTIONUpdate confirms multimodal analgesia (NSAIDs, acetaminophen, gabapentinoids, local anesthetics/blocks) outperforms opioid-only regimens after joint arthroplasty, though IV acetaminophen and liposomal bupivacaine lack strong supporting evidence.
Abstract, as published

➤: Multimodal analgesia has become the standard of care for total joint arthroplasty as it provides superior analgesia with fewer side effects than opioid-only protocols.

➤: Systemic medications, including nonsteroidal anti-inflammatory drugs, acetaminophen, corticosteroids, and gabapentinoids, and local anesthetics via local infiltration analgesia and peripheral nerve blocks, are the foundation of multimodal analgesia in total joint arthroplasty.

➤: Ideally, multimodal analgesia should begin preoperatively and continue throughout the perioperative period and beyond discharge.

➤: There is insufficient evidence to support the routine use of intravenous acetaminophen or liposomal bupivacaine as part of multimodal analgesia protocols.

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