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Closing the Gaps in Postsurgical Pain Management.

Giles R Scuderi1

  • 1Orthopedic Service Line, North Shore-LIJ Health System, New York, NY.

American Journal of Orthopedics (Belle Mead, N.J.)
|October 9, 2015
PubMed
Summary

Preventing inadequate pain control after joint replacement surgery is crucial. Balanced multimodal analgesia, combining various medications and scheduled administration, effectively manages post-operative pain.

Area of Science:

  • Pain Management
  • Anesthesiology
  • Orthopedic Surgery

Background:

  • Analgesic gaps, or periods of inadequate pain control, frequently complicate post-joint arthroplasty pain management.
  • These gaps can significantly impair patient recovery and satisfaction.

Purpose of the Study:

  • To highlight the importance of preventing analgesic gaps after joint arthroplasty.
  • To advocate for the use of well-designed, multimodal analgesic regimens.

Main Methods:

  • Utilizing a combination of analgesic agents targeting both peripheral and central nervous systems.
  • Incorporating medications such as acetaminophen, COX-2 inhibitors, gabapentinoids, glucocorticoids, periarticular injections (e.g., bupivacaine HCl, liposomal bupivacaine), and long-acting opioids.
  • Considering the mechanisms of action, onset, and duration of individual medications for optimal regimen design.

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Main Results:

  • Multimodal analgesia, when carefully planned, effectively prevents analgesic gaps.
  • Scheduled administration of medications, rather than as-needed dosing, is vital for sustained pain control.
  • Balanced regimens ensure continuous pain management by addressing different pain pathways.

Conclusions:

  • Preventable analgesic gaps significantly impact post-arthroplasty care.
  • A comprehensive multimodal approach, considering drug properties and administration timing, is essential for optimal pain control.
  • Scheduled multimodal analgesia is key to avoiding the reestablishment of pain pathways and improving patient outcomes.