Assuring a painless total hip arthroplasty: a multimodal approach emphasizing peripheral nerve blocks.

Abstract

A highly effective comprehensive multimodal pain protocol has evolved at our institution for both primary and revision hip and knee arthroplasty. At the center of this protocol are peripheral nerve blocks to deliver postoperative pain relief. Total hip arthroplasty patients receive a lumbar plexus block with an indwelling catheter. Total knee arthroplasty patients receive a femoral nerve block with an indwelling catheter and also get a single-shot sciatic nerve block. Before surgery, patients are given a long-acting oral narcotic medication and a nonsteroidal anti-inflammatory. After surgery, oral medications are given on a set schedule and include acetaminophen, a nonsteroidal anti-inflammatory, and a long-acting oral narcotic. Outstanding pain control is achieved without parenteral narcotics and allows early physical therapy, early return to self-care, and improved patient satisfaction.

• Authors: Mark W Pagnano, James Hebl, Terese Horlocker
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 21 Issue 4 Suppl 1 Pg. 80-4 (Jun 2006) ISSN: 0883-5403 [Print] United States
• PMID: 16781436 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics
• Anti-Inflammatory Agents, Non-Steroidal

Topics

• Analgesics (adverse effects, therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal
• Arthroplasty, Replacement, Hip (methods, rehabilitation)
• Humans
• Intraoperative Period
• Length of Stay
• Nerve Block (methods)
• Pain Measurement
• Pain, Postoperative (prevention & control)
• Peripheral Nerves
• Postoperative Period
• Preoperative Care
• Reproducibility of Results
• Walking