Skip to main content
Published Online:https://doi.org/10.3928/01477447-20100722-38Cited by:2

Abstract

Enhancement of our perioperative pain management protocols has resulted in accelerated rehabilitation. At our facility, the majority of patients undergoing total and partial knee arthroplasty are treated with a single-shot spinal anesthetic consisting of a combination of bupivacaine and duramorph. The bupivacaine affords the immediate perioperative anesthetic while the duramorph results in sustained analgesia for a period of 12 to 24 hours. We use intra-articular injections delivered directly into the soft tissue of the knee. Our current intra-articular injection is 60 mL of 0.5% ropivacaine with 0.5 mg of epinephrine. In patients with a normal renal function, 30 mg of ketorolac is added. The injection is administered throughout all of the soft tissues in and around the knee. Prophylactic antiemetics are administered in the form of dexamethasone, ondansetron, and a scopolamine patch. The use of this perioperative anesthesia provides effective pain relief with no motor blockade. Patients are able to participate in physiotherapy within several hours of the operative procedure, performing active range of motion and ambulating with assistive devices. Patients with no significant cardiovascular history are given celecoxib preoperatively, which is continued for approximately 2 weeks postoperatively. Additionally, all patients are treated with oxycodone, either preoperatively or within 2 hours of arrival to the floor postoperatively. Patients younger than 70 years are given 20 mg of oxycodone while those older than 70 years are given 10 mg of oxycodone. The oxycodone is continued for the first 24 hours of the hospital stay. Patients are then managed with oxycodone and hydrocodone. Length of stay has decreased and currently averages <2 days.

  • 1.Berend KR, Lombardi AV, Mallory TH. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int. 2004; (13):239–247.

    MedlineGoogle Scholar
  • 2.Lombardi AV, Viacava AJ, Berend KR. Rapid recovery protocols and minimally invasive surgery help achieve high knee flexion. Clin Orthop Relat Res. 2006; (452):117–122.10.1097/01.blo.0000238824.56024.7a

    Crossref MedlineGoogle Scholar
  • 3.Meding JB, Klay M, Healy A, Ritter MA, Keating EM, Berend ME. The prescreening history and physical in elective total joint arthroplasty. J Arthroplasty. 2007; 22(6 Suppl 2):21–23.10.1016/j.arth.2007.03.035

    Crossref MedlineGoogle Scholar
  • 4.Gherini S, Vaughn BK, Lombardi AV, Mallory TH. Delayed wound healing and nutritional deficiencies after total hip arthroplasty. Clin Orthop Relat Res. 1993; 293:188–195.

    CrossrefGoogle Scholar
  • 5.Berend KR, Ajluni AF, Núñez-García LA, Lombardi AV, Adams JB. Prevalence of obstructive sleep apnea and management in patient undergoing total joint arthroplasty. J Arthroplasty. 2010. In press.10.1016/j.arth.2010.04.034

    CrossrefGoogle Scholar
  • 6.Marchant MH, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009; 91(7):1621–1629.10.2106/JBJS.H.00116

    Crossref MedlineGoogle Scholar
  • 7.van Klei WA, Bryson GL, Yang H, Forster AJ. Effect of beta-blocker prescription on the incidence of postoperative myocardial infarction after hip and knee arthroplasty. Anesthesiology. 2009; 111(4):717–724.10.1097/ALN.0b013e3181b6a761

    Crossref MedlineGoogle Scholar
  • 8.Mallory TH, Lombardi AV, Fada RA, Dodds KL. Anesthesia options: choices and caveats. Orthopedics. 2000; 23(9):919–920.

    LinkGoogle Scholar
  • 9.Mallory TH, Lombardi AV, Fada RA, Dodds KL, Adams JB. Pain management for joint arthroplasty: preemptive analgesia. J Arthroplasty. 2002; 17(4 suppl 1):129–133.10.1054/arth.2002.32460

    Crossref MedlineGoogle Scholar
  • 10.Lombardi AV, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res. 2004; (428):125–130.10.1097/01.blo.0000147701.24029.cc

    Crossref MedlineGoogle Scholar
  • 11.Fu P, Wu Y, Wu H, Li X, Qian Q, Zhu Y. Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty–a randomized controlled trial. Knee. 2009; 16(4):280–284.10.1016/j.knee.2008.12.012

    Crossref MedlineGoogle Scholar
  • 12.Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res. 2009; 467(6):1418–1423.10.1007/s11999-009-0728-7

    Crossref MedlineGoogle Scholar
  • 13.Thoms RJ, Marwin SE. The role of fibrin sealants in orthopaedic surgery. J Am Acad Orthop Surg. 2009; 17(12):727–736.

    Crossref MedlineGoogle Scholar

We use cookies on this site to enhance your user experience. For a complete overview of all the cookies used, please see our privacy policy.

×