Updates on Multimodal Analgesia for Orthopedic Surgery

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pharmacology

Background:

• Postoperative pain control after orthopedic surgery presents significant challenges.
• The ongoing opioid epidemic necessitates alternatives to traditional opioid-based analgesia.
• Multimodal analgesia, combining various agents, offers superior pain management with reduced side effects.

Purpose of the Study:

• To evaluate the evidence for nonopioid analgesics in multimodal pain management after orthopedic surgery.
• To review newly available and established nonopioid agents for postoperative pain control.
• To discuss the cost-effectiveness of these agents within a multimodal framework.

Main Methods:

• Literature review of recent nonopioid analgesic agents.
• Evaluation of established medications (ketamine, gabapentinoids) in multimodal regimens.
• Analysis of evidence supporting efficacy and safety in orthopedic postoperative pain.

Main Results:

• Intravenous acetaminophen, intranasal ketorolac, newer NSAIDs, ketamine, and gabapentinoids show promise in multimodal analgesia.
• Nonopioid combinations provide superior pain relief compared to opioids alone.
• These strategies can mitigate opioid-related side effects and contribute to addressing the opioid crisis.

Conclusions:

• A multimodal approach incorporating newer and established nonopioid agents is effective for postoperative orthopedic pain.
• This strategy offers a safer alternative to sole reliance on opioids.
• Further research into cost-effectiveness and long-term outcomes is warranted.