• Aaron J Krych, Terese T Horlocker, James R Hebl, and Mark W Pagnano.
• Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
• Instr Course Lect. 2010 Jan 1;59:99-109.

AbstractThe introduction of minimally invasive total knee arthroplasty has been accompanied by substantial changes in anesthesia and analgesia techniques. It is well recognized that the goals of minimally invasive surgery, which include rapid rehabilitation and improved patient function, cannot be achieved without excellent postoperative analgesia. Traditional postoperative pain management has been associated with high rates of suboptimal pain control, however. The conventional options for early postsurgical pain management include indwelling epidural catheters, which require changes in postoperative prophylaxis for thromboembolism, and patient-controlled analgesia pumps, which are associated with fluctuating pain levels and inconsistent pain relief. Numerous adverse effects are associated with traditional opioid medications, including respiratory depression, urinary retention, nausea, sedation, constipation, and pruritus. Safe, effective, and well-tolerated early pain relief after a minimally invasive knee replacement can be accomplished using a multimodal oral pain regimen, peripheral nerve blocks, and local injections.

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