Multimodal Pain Management in Orthopedic Surgery

被引:16
作者
Chunduri, Aparna [1 ]
Aggarwal, Amit Kumar [1 ]
机构
[1] Univ Texas Med Branch Galveston, Dept Anesthesiol, Galveston, TX 77555 USA
关键词
multimodal analgesia; orthopedic surgery; pain management; anesthesiology; opioids management; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; POSTOPERATIVE PAIN; OPIOID THERAPY; DOUBLE-BLIND; PARACETAMOL; ARTHROPLASTY; ANESTHESIA; ANALGESIA; CAPSAICIN; KETAMINE;
D O I
10.3390/jcm11216386
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Orthopedic surgery typically results in moderate to severe pain in a majority of patients. Opioids were traditionally the primary medication to target mechanisms of pain transmission. Multimodal analgesia has become a preferred method of pain management in orthopedic practice. Utilizing more than one mode to address post-surgical pain by recruiting multiple receptors through different medications accelerates the recovery process and decreases the need for opioids. By implementing effective analgesic techniques and interventions, this practice, in turn, decreases the usage of perioperative opioids, and in the long term, prevents addiction to pain medications and risk of opioid overdose. In orthopedic surgeries, previous studies have found that multimodal analgesia has reduced early opioid usage in the postoperative course. Pain is the result of direct injury to the nervous system, with a wide variety of chemicals directly stimulating or sensitizing the peripheral nociceptors. The pathophysiology behind the mechanism of post-surgical pain, along with the importance of preoperative, perioperative, and postoperative pain regimens are emphasized. A brief overview of pain medications and their properties is provided. These medications are further categorized, with information on special considerations and typical dosage requirements. Pain management should address both neuropathic and subjective types of pain. Effective pain control requires constant reassessment with individualized strategies. Conclusion: By focusing on multimodal analgesia, anesthesiologists can now utilize newer techniques for postoperative pain relief from orthopedic surgery, with better short-term and long-term outcomes for the patient.
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页数:13
相关论文
共 46 条
[1]   Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch [J].
Anand, P. ;
Bley, K. .
BRITISH JOURNAL OF ANAESTHESIA, 2011, 107 (04) :490-502
[2]  
[Anonymous], PALL DRUGS PREG
[3]   Management of Pain in the United States-A Brief History and Implications for the Opioid Epidemic [J].
Bernard, Stephen A. ;
Chelminski, Paul R. ;
Ives, Timothy J. ;
Ranapurwala, Shabbar I. .
HEALTH SERVICES INSIGHTS, 2018, 11
[4]   Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity Systematic Review and Meta-analysis of Randomized Controlled Trials [J].
Blaudszun, Gregoire ;
Lysakowski, Christopher ;
Elia, Nadia ;
Tramer, Martin R. .
ANESTHESIOLOGY, 2012, 116 (06) :1312-1322
[5]   Trends in Use of Opioids by Noncancer Pain Type 2000-2005 Among Arkansas Medicaid and HealthCore Enrollees: Results From the TROUP Study [J].
Braden, Jennifer Brennan ;
Fan, Ming-Yu ;
Edlund, Mark J. ;
Martin, Bradley C. ;
DeVries, Andrea ;
Sullivan, Mark D. .
JOURNAL OF PAIN, 2008, 9 (11) :1026-1035
[6]   Role of β-blockade in anaesthesia and postoperative pain management after hysterectomy [J].
Chia, YY ;
Chan, MH ;
Ko, NH ;
Liu, K .
BRITISH JOURNAL OF ANAESTHESIA, 2004, 93 (06) :799-805
[7]   Rectal paracetamol has a significant morphine-sparing effect after hysterectomy [J].
Cobby, TF ;
Crighton, IM ;
Kyriakides, K ;
Hobbs, GJ .
BRITISH JOURNAL OF ANAESTHESIA, 1999, 83 (02) :253-256
[8]  
Crile GW, 1913, LANCET, V2, P7
[9]  
Dafny N, PAIN PRINCIPLES
[10]   Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals [J].
Fosbol, Emil Loldrup ;
Folke, Fredrik ;
Jacobsen, Soren ;
Rasmussen, Jeppe N. ;
Sorensen, Rikke ;
Schramm, Tina Ken ;
Andersen, Soren S. ;
Rasmussen, Soren ;
Poulsen, Henrik Enghusen ;
Kober, Lars ;
Torp-Pedersen, Christian ;
Gislason, Gunnar H. .
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2010, 3 (04) :395-405