Postoperative Analgesia in Total Knee Arthroplasty (Tka)-The Changing Trends
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 3
Abstract
Joint replacement surgeries are considered as one of the most painful procedure in orthopedics. Achieving complete and long term pain relief starts from the time of surgery, and perhaps even before the surgery. The traditional approached involved high dose opioid based regimen, though opioid are considered strong analgesic, but are associated with number of unwanted side effects which lead the researcher to sought for alternative techniques. Neuraxial techniques (intrathecal long acting opioid) and continuous epidural analgesia were popular and were accepted by many but they also have limitations and drawback, after epidural analgesia, next popular technique that has evolve major nerve block namely femoral and sciatic, of which femoral nerve block (FNB) seems to provide equianalgesia to epidural without the side effects of epidural. The role of sciatic nerve block in TKA pain is doubtful. FNB still hold its place and many expert consider femoral nerve block as gold standard, however, FNB is associated with quadriceps weakness and risk of fall and sciatic block with foot drop. To overcome these drawback- more distal nerve block techniques has evolved- namely saphenous nerve block in adductor canal, selective tibial which are claimed to provide comparable analgesia to that of femoral and sciatic nerve block. The combination of pre-emptive and multi-modal analgesia and technically well delivered regional nerve blocks and postoperative physical therapy are essential component which not only minimize the side effects of traditional opioid based analgesia but also speed up functional recovery, increases patient satisfaction and reduces overall length of hospitalisation and cost.Optimal postoperative analgesia after total knee arthroplasty is the key for earlier recovery and functional outcomes. Joint replacement surgeries are one of the most painful orthopaedic procedure. Inadequate or poorly treated postoperative pain after major joint replacement surgery not only significantly prolongs the rehabilitation process, increased risk of other complications, sometime progress as persistent postoperative pain into chronic pain and it also prolonged the overall length of hospitalization and cost [1]. Achieving complete and long term pain relief starts from the time of surgery, and perhaps even before the surgery. Adequate perioperative analgesia is the key to success after knee arthoplasty surgeries, to maintain long term pain relief and functional recovery after the surgery. Early joint mobilization with initiation of physical therapy is one of the important aspects to achieve successful outcome after total knee arthoplasty [2]. Despite the introduction of newer drugs and techniques and better understanding of postoperative pain mechanism, majority of patients still suffer from extreme pain immediately after surgery that often progress into chronic pain [3-6].
Authors and Affiliations
Surjya Prasad Upadhyay, Sudhakar Tellicherry, Sunil Kulkarni, Partha P Saikia M, Piyush N Mallick, Waleed Elmatite
Keywords
Related Articles
- EP ID EP571681
- DOI 10.26717/BJSTR.2017.01.000284
- Views 176
- Downloads 0
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