[Pain therapy for the lower extremities]

Area of Science:

• Orthopaedic Surgery
• Pain Management
• Anesthesiology

Background:

• Postoperative pain significantly impacts patient mobility and recovery after lower extremity surgery.
• Current practices often involve systemic analgesics, which may be suboptimal.
• Regional anesthetic and intrathecal procedures offer potential for improved analgesia.

Purpose of the Study:

• To review and recommend optimal pain therapy strategies following lower extremity surgical procedures.
• To compare the efficacy of regional versus systemic analgesia.
• To identify effective surgical and non-surgical adjuncts for pain reduction.

Main Methods:

• Review of current literature on pain management in lower extremity surgery.
• Analysis of regional anesthetic techniques (e.g., intrathecal, intra-articular).
• Evaluation of pharmacologic (opioids, non-opioids) and non-pharmacologic (cooling, physiotherapy) interventions.

Main Results:

• Regional analgesic regimens are more effective than systemic therapy for lower extremity surgery.
• Intra-articular injections of local anesthetics, potentially with opioids, are beneficial.
• Preoperative systemic analgesics are not recommended; postoperative non-opioids and opioids are advised.
• Cooling and physiotherapy enhance pain reduction after joint procedures.
• No scientific rationale supports the use of drains for pain management.

Conclusions:

• Regional anesthesia and multimodal analgesia are superior to systemic approaches for postoperative pain control in lower extremity surgery.
• Orthopaedic surgeons have various effective tools for managing surgical pain, emphasizing regional techniques and adjunct therapies.
• Optimizing pain management is essential for improving patient mobility and accelerating convalescence.