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Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty

Moucha, Calin Stefan MD; Weiser, Mitchell C. MD, MEng; Levin, Emily J. MD

Journal of the American Academy of Orthopaedic Surgeons: February 2016 - Volume 24 - Issue 2 - p 60–73
doi: 10.5435/JAAOS-D-14-00259
Review Article

Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia—incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods—can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

From the Department of Orthopaedic Surgery (Dr. Moucha and Dr. Weiser) and the Department of Anesthesiology (Dr. Levin), Icahn School of Medicine at Mount Sinai, New York, NY.

Dr. Moucha or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of 3M and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Dr. Weiser serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Weiser and Dr. Levin.

© 2016 by American Academy of Orthopaedic Surgeons
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