Pain Management Research

An Update on Multimodal Pain Management After Total Joint Arthroplasty

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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.

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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.

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

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

Strategies to Standardize Opioid Research and Improve Clinical Pain Management

Opioid abuse results in poor pain control, poor outcomes, and addiction. Clinical recommendations to manage pain include identifying the problem, considering multimodal anesthesia, avoiding overprescribing, acknowledging that minimizing opioid use is not equivalent to undertreating pain, minimizing preoperative opioid use, managing patient expectations, and continuing to investigate outcomes of pain management while limiting opioid prescriptions or forgoing opioids altogether. Authors are directed to new Recommendations for Pain Management Research to highlight critical research parameters and standardize outcome reporting.