Pain management in patients who undergo outpatient arthroscopic surgery of the knee

Arthroscopy of the knee joint produces an initial afferent barrage of pain signals that have the capacity to initiate prolonged changes in the nervous system leading to the amplification and prolongation of postoperative pain. Preemptive analgesia involves the administration of analgesics prior to painful stimuli to prevent the amplification of postoperative pain. It is currently recommended that multimodal analgesic regimens be utilized in the management of postoperative pain. Intra-articular bupivacaine and morphine are effective analgesics for arthroscopic knee surgery. Intra-articular ketorolac, corticosteroids, and clonidine may also have a role in reducing pain following arthroscopic knee surgery. Nonsteroidal anti-inflammatory drugs play an important role in the management of postoperative orthopaedic pain, and the newer cyclooxygenase-2-specific nonsteroidal anti-inflammatory drugs may have additional advantages with respect to safety. Preemptive and multimodal analgesic techniques should be utilized in the management of patients undergoing anterior cruciate reconstruction.