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Implementing Evidence-Based, Phase-Specific Multimodal Analgesia for Total Joint Arthroplasty: An Interprofessional
Qiuru Wang1, Dongmei Zhao2,3, Jian Hu4
1Department of Orthopedic Surgery, West China Hospital of Sichuan University, 37# Wainan Guoxue Road, Chengdu 610041, China, wchscu.cn.
Journal of Nursing Management
|August 13, 2026
Summary
Enhanced recovery after surgery (ERAS) pathways for total joint arthroplasty (TJA) optimize pain management through multimodal analgesia. Nursing leadership is crucial for coordinating patient-centered care and improving outcomes.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Nursing Science
Background:
- Enhanced Recovery After Surgery (ERAS) pathways are increasingly adopted for total joint arthroplasty (TJA).
- Optimizing perioperative pain management is critical for patient recovery and functional outcomes in TJA.
- Multimodal analgesia offers a synergistic approach to pain control, combining various pharmacologic and non-pharmacologic methods.
Purpose of the Study:
- To synthesize current evidence on perioperative multimodal analgesia within ERAS pathways for TJA.
- To provide actionable insights for nursing management and interprofessional collaboration in TJA pain management.
- To emphasize the pivotal role of nurses in orchestrating patient-centered pain management to optimize TJA outcomes.
Main Methods:
- A structured narrative review was conducted.
- Searches were performed in PubMed and MEDLINE for English-language publications up to June 2025.
- Evidence was synthesized prioritizing randomized controlled trials, cohort studies, clinical practice guidelines, systematic reviews, meta-analyses, and landmark studies.
Main Results:
- Multimodal analgesia, combining pharmacologic and non-pharmacologic techniques, is standard for TJA.
- Phase-specific protocols include preemptive analgesics, intraoperative local infiltration analgesia (LIA), and a nursing-led postoperative
- non-opioid-first
- strategy.
- For total knee arthroplasty (TKA), evidence supports adductor canal block (ACB), IPACK block, and LIA for optimal analgesia and motor function preservation.
Conclusions:
- Personalized multimodal analgesia elevates the nursing role to essential clinical decision-making and care coordination.
- Nursing leadership is vital for bridging evidence-to-practice gaps, minimizing variation, and ensuring patient safety in ERAS programs.
- Future efforts should focus on implementation science, protocol governance, and workforce development for sustainable integration of ERAS pathways.
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