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Multimodal Pain Management After Total Joint Arthroplasty

Parvizi, Javad MD, FRCS; Miller, Adam G. MD; Gandhi, Kishor MD

Journal of Bone & Joint Surgery - American Volume: 1 June 2011 - Volume 93 - Issue 11 - p 1075–1084
doi: 10.2106/JBJS.J.01095
Current Concepts Review

Adequate postoperative pain control in patients who have undergone total joint arthroplasty allows faster rehabilitation and reduces the rate of postoperative complications.

Multimodal pain management involves the introduction of adjunctive pain control methods in an attempt to control pain with less reliance on opioids and fewer side effects.

Current research suggests that traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and the associated cyclooxygenase type-2 (COX-2) inhibitors improve pain control in most cases.

Nearly all multimodal pain management modalities have a safe side-effect profile when they are added to existing methods. The exception is the administration of DepoDur (extended-release epidural morphine) to elderly or respiratory-compromised patients because of a potential for hypoxia and cardiopulmonary events.

1Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for J. Parvizi:

2Department of Anesthesiology, Thomas Jefferson University, 111 South 11th Street, Suite 6201, Philadelphia, PA 19107

Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated
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