Here at Duke University Medical Center, we routinely perform such painful procedures as total shoulder replacements, total ankle replacements and unicondylar arthroplasties on an outpatient basis, thanks in large part to an aggressive multimodal approach to pain control. The cornerstone of our program is peripheral nerve blockade, which we continue for 24 to 72 hours postoperatively via pain-pump infusion in nearly one-third of all blocked patients. Many studies and our own experience with more than 1,500 such patients show that this technique improves analgesia over traditional approaches and reduces opioid use, thereby reducing narcotic-related side effects.