Post-operative pain management in patients undergoing total knee arthroplasty: A literature review
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Gentner, Luke, Hervey, Quay, Lahey, Ryan. 2019. Post-operative pain management in patients undergoing total knee arthroplasty: A literature review -- In Proceedings: 15th Annual Symposium on Graduate Research and Scholarly Projects. Wichita, KS: Wichita State University
INTRODUCTION: Total knee arthroplasty (TKA) is one of the most effective treatment options for patients with severe knee osteoarthritis; however, this procedure is known to cause significant post-operative pain. Prolonged post-operative pain can predispose individuals to a prolonged and complex recovery. Managing variable responses to pain post TKA proves to be a significant challenge for both providers and patients. The purpose of this review is to investigate optimal pain management strategies for patients following TKA. METHODS: A literature search was conducted and included the following databases Medline, CINHAL, Cochrane library. Search terms or related terms included total knee arthroplasty, joint arthroplasty, opioids, post-operative, pain management, pain. Articles were then identified and reviewed based on relevance, type of study, and age of the study. RESULTS: Seven adjunctive pain management therapies were identified and include: Cox-2 specific inhibitors, Tylenol® , ketamine, corticosteroids, gabapentinoids, peri- and intra-articular knee injections, and physical therapy. Articles found concluded that therapies effective for reducing postoperative TKA pain included: Cox-2 specific inhibitors, Tylenol®, ketamine, corticosteroids, peri- and intra-articular knee injections. Therapies that reduced opioid consumption acutely in the TKA post-operative setting included Cox-2 specific inhibitors, Tylenol®, ketamine, gabapentinoids, peri- and intra-articular knee injections. Preoperative physical therapy did not decrease pain scores in the TKA postoperative setting. CONCLUSION: A multimodal treatment strategy is the most effective for reducing post-operative pain following TKA. This technique should include utilizing Cox-2 inhibitors, Tylenol®, ketamine, corticosteroids, gabapentinoids, peri- and intra-articular injections tailored to each individual patient.
Presented to the 15th Annual Symposium on Graduate Research and Scholarly Projects (GRASP) held at the Rhatigan Student Center, Wichita State University, April 26, 2019.
Research completed in the Department of Physician Assistant, College of Health Professions