Pain Management in Total Joint Arthroplasty: A Historical Review

摘要

Pain after hip and knee arthroplasty surgery is severe. Failure to provide adequate analgesia impedes aggressive physical therapy and rehabilitation, which is critical to maintaining joint range of motion, and potentially delays hospital dismissal as well as increase the risk of thromboembolism. Traditionally, postoperative analgesia following total joint replacement was provided by either intravenous patient-controlled analgesia (PCA) or epidural analgesia. However, each technique has distinct advantages and disadvantages. For example, opioids do not consistently provide adequate pain relief and often cause sedation, confusion and delirium, constipation, nausea and vomiting, and pruritus. Epidural infusions containing local anesthetics (with or without an opioid) provide superior analgesia but are associated with hypotension, urinary retention, motor block limiting ambulation, and spinal hematoma secondary to anticoagulation.