Current Concepts in Pain Management of Total Knee Replacement Surgeries: A Narrative Review

Abstract

Total knee replacement/arthroplasty (TKR/TKA) is considered a life-changing surgery as it not only corrects the pathology and associated joint deformity but also renders the patient pain-free allowing them to perform activities of daily living as before. Such favorable outcomes depend entirely on the perioperative pain management strategies. Structuring such strategies requires background knowledge of the goals set, the process of pain generation before and after the surgery, and innervations of the pain-generating components involved in each surgical step. The multifactorial origin of TKR pain requires a multidimensional pain management strategy such as multimodal analgesia (MMA). It should incorporate all the essential ingredients that target each step of the pain generation process. Apart from pharmacological agents and nonpharmacological techniques, regional analgesia (RA) plays a very important role as an adjunct to MMA to provide quality analgesia that promotes enhanced recovery and mobility. However, the choice of RA technique remains dependent on its motor-sparing effect, procedure-specific analgesic coverage, opioid-sparing effect, and suitability for enhanced recovery after surgery (ERAS). Psychological analgesia is also an important aspect of MMA, aiding in resolving psychological concerns and postoperative pain management and empowering patients in their own pain management process by encouraging active participation. In addition to providing appropriate pain management services, assessing expected outcomes in the postoperative period is also important to close loopholes and provide rescue analgesics when needed. This narrative review article highlights important aspects of pain management strategies and the essential requirements for implementing them to achieve desired outcomes. We believe this article will help readers design or modify their pain management strategy to meet all of their goals. Keywords: Total knee replacement, Total knee arthroplasty, Pain management, Motor-sparing regional anesthetic technique, Multimodal analgesia, Procedure-specific analgesia.