• Calin Stefan Moucha, Mitchell C Weiser, and Emily J Levin.
• From the Department of Orthopaedic Surgery (Dr. Moucha and Dr. Weiser) and the Department of Anesthesiology (Dr. Levin), Icahn School of Medicine at Mount Sinai, New York, NY.
• J Am Acad Orthop Surg. 2016 Feb 1; 24 (2): 60-73.

AbstractTotal knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

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