Periop Pain Management in Total Knee Replacement

    Could periarticular injections control pain as effectively as nerve blocks while eliminating the complications of the blocks?


    Mark J. Spangehl, MD, and Henry D. Clarke, MD

    Pain management following orthopaedic surgery has greatly evolved since the 1980s, when intramuscular injections and intravenous infusions of opioids were the mainstays of treatment. Today’s total joint replacement patients can expect their surgeons to take a multimodal approach to pain management that more effectively addresses pain at multiple pathways while minimizing the use of opioids.

    The multimodal approach adopted by orthopaedic surgeon at Mayo Clinic in the mid-2000s included preemptive pain management oral analgesics, peripheral nerve blocks, and sciatic nerve blocks delivered as either a single shot or an infusion through an indwelling catheter. This approach was effective, but there were complications from the nerve blocks, including delayed mobilization, falls, and neurologic complaints.

    Based on the growing body of literature supporting intraoperative use of periarticular injections for pain management, we conducted a prospective, randomized study comparing periarticular injections with peripheral nerve blocks to determine if these injections could provide adequate pain control while eliminating the complications associated with nerve blocks in patients undergoing primary total knee replacement.

    The answer was yes, and as a result of our findings, we have changed our practice to include periarticular injections as part of a multimodal pain management strategy for routine primary total knee replacement.

    This video details the study methodology and findings and reviews our current technique for periarticular injection.

    Click the image below to start the video.

    Author Information

    Mark J. Spangehl, MD, is Associate Professor of Orthopaedics, Mayo Clinic College of Medicine, Phoenix, Arizona. Henry D. Clark, MD, is Professor of Orthopaedics, Mayo Clinic College of Medicine, Phoenix, Arizona.