As total joint replacements shift increasingly to the outpatient setting, physicians are taking a new, “multimodal” approach to pain management.
According to a recent study published in he Journal of Arthroplasty, reported out by MedPage Today, physicians who perform TJR are evaluating what types of anesthesia and analgesia are most effective for outpatient TJR procedures.
Here are 10 takeaways from the report:
1. In May 2023, the American Association of Hip and Knee Surgeons conducted a survey which was emailed to all practicing adult-reconstruction members of the AAHKS and compared the results to a similar survey conducted in 2018. The goal was to investigate whether updated clinical guidelines changed how physicians and practices managed TJR pain.
2. The response rate to the survey was 16.5%. Respondents were in practice for a mean of 17.7 years.
3. A total of 84% said they had performed more than 200 arthroplasty surgeries in 2022, and 88% did outpatient surgery.
4. Of those who performed outpatient surgery, 87% used the same anesthesia and analgesia protocols for inpatient and outpatient procedures.
5. Twenty-eight percent of respondents initiated preemptive analgesia the day before surgery and most commonly provided acetaminophen, celecoxib and meloxicam.
6. Conversely, 92% of respondents used preemptive analgesia on the day of surgery, one to two hours before an incision was made.
7. For anesthesia, spinals using bupivacaine, mepivacaine, and ropivacaine were the most common anesthetics used for total hip arthroplasty and total knee arthroplasty.
8. For total knee arthroplasty, 83% of surgeons used peripheral nerve blocks, compared with just 18% of those for total hip arthroplasty.
9. Notably, opioid prescription for post-TJR recovery declined 35% for knee replacements and 59% for hip replacements. Only one respondent in the survey reported using patient-controlled anesthesia with intravenous opioids after TKA or THA.
10. Additionally, 92% of the respondents stated that they use multimodal analgesics with opioids, most commonly acetaminophen, celecoxib, anti-nausea medications, meloxicam , gastroprotective medications, and gabapentinoids.
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