10:41 AM

Help Total Knee Patients Recover in Comfort

Outpatient Surgery Magazine discusses alternative therapies to reduce a patient’s reliance on opioids to manage post-op pain following total knee arthroplasty (TKA) according to experts.

HSS anesthesiologist Ellen M. Soffin, MD, PhD, explained providers have learned to reduce pain after TKA for the initial 24 hours post-op through the use of peripheral nerve blocks, local infiltration analgesia and multimodal pain relief. “But when the blocks wore off, patients were uncomfortable, and often had sudden high requirements for opioids to treat breakthrough pain," she cited. The goal now is to find ways to take these techniques to the next level by extending the duration of pain relief without the use of opioids. "One solution has been to add an adjuvant, like steroids, to local anesthetics," said Dr. Soffin. "Extended duration formulations of local anesthetics are also increasingly being applied to total knee arthroplasty, but their cost relative to outcome benefits remains to be fully established.”

The guiding principle of your multimodal regimen should be that the medications are acting at different sites in the central and peripheral nervous systems. This creates a synergistic effect on pain control while minimizing the side effects associated with any individual agent, said Dr. Soffin.

Experts including Dr. Soffin agree that reducing the overall number of opioids prescribed after surgery requires educating patients on expectations for their post-op recoveries and establishing realistic expectations of the pain they'll experience. Dr. Soffin noted while some facilities might lack the necessary resources to adopt opioid-free total knee arthroplasty, "But rather than abandon the goal entirely, they can implement an incremental approach.”

She concluded, "Elements of an opioid-sparing approach should be achievable, and they will help to protect patients and improve outcomes.”

Read the full article at Outpatientsurgery.net.