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Archive Anesthesia 2020

Help Total Knee Patients Recover in Comfort

Alternative therapies reduce their reliance on opioids to manage post-op pain.

Kendal Gapinski

Kendal Gapinski, Contributing Editor


SOME NERVE Extending the effect of regional blocks is key to keeping patients comfortable beyond the first day of recovery.

There's a straightforward way to reduce the number of complications following total knee replacements and improve the recoveries of patients who undergo these notoriously painful procedures: Stop relying on opioids to provide pain relief.

It's been know for years that opioid-related side effects — PONV, constipation, sedation and respiratory depression — limit short-term recovery from total knees. Providers and patients are now becoming increasingly aware of the long-term negative effects of using opioids to manage post-op pain. For example, approximately 6% of opioid-na├»ve patients will still be taking the painkillers up to 6 months after surgery, according to Ellen M. Soffin, MD, PhD, an anesthesiologist at the Hospital for Special Surgery in New York City.

The trend to go "opioid-free" sounds like a worthwhile goal to manage the post-op pain of total knee patients and reduce their risk of long-term opioid dependence, but you don't need to totally eliminate the use of opioids to enhance recoveries. Focus on opioid-sparing techniques instead of trying to eliminate their use altogether, suggests Girish P. Joshi, MBBS, MD, FFARCSI, a professor of anesthesiology and pain management at the University of Texas Southwestern Medical Center in Dallas.

"Studies have shown that the judicious use of intraoperative opioids can be beneficial to a multimodal pain management plan," he says. "The primary aim is to use less opioids than you used before."

Accomplishing that goal requires your anesthesia team to target and block sensory nerves and administer non-opioid analgesic agents.

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