• Juliusz Kosel, Piotr Bobik, and Andrzej Siemiątkowski.
• Department of Anesthesiology and Intensive Care, Medical University of Bialystok, Poland.
• Ortop Traumatol Rehabil. 2012 Jul 1;14(4):315-28.

AbstractDuring last 30 years orthopedic surgery dramatically improved. The most significant progress had place in joint surgery. Today in many orthopedic centers total hip and knee arthroplasties are made and may be counted in hundreds per year. Surgeons can choose among many different implant operation systems. Nevertheless this type of operations is connected with pain in immediate postoperative course. The aim of the paper was presentation of contemporary methods of pain management after big knee surgery, especially after total knee arthroplasty (TKA). Among presented methods of pain management the anesthetic techniques were discussed: epidural anesthesia (EA) and peripheral nerves blocks (PNB). They seem to be most interesting and evolutionary because of possibility of early ambulation and more effective postoperative rehabilitation. It directly corresponds to therapeutic effect of surgical procedure and patient's satisfaction. In the paper there are presented advantages and possible complications of regional techniques, particular block techniques and technical problems with possible modifications of pain management. This review is based on latest medical literature, especially on metaanalyses published during last few years comparing different modes of postoperative pain management.

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