Instructional course lectures
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The decision to use regional or general anesthesia for patients undergoing total joint arthroplasty continues to be controversial. Recent reviews of the literature support the growing trend for the use of regional anesthesia with a multifaceted approach, spanning nuances in block placement as well as pharmacologic agents and delivery systems. Innovative developments offer appealing options and encouraging results for the management of pain after major orthopaedic procedures. The ultimate decision, although varied, requires careful preoperative planning and protocols to ensure adequate pain control and patient satisfaction.
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Pain control following total joint arthroplasty is critical for optimizing patient outcome. Both the real and perceived success of joint arthroplasty surgery depends on the patient's level of pain in the postoperative period. ⋯ Optimal pain control must be balanced against the adverse effects of narcotics, including alteration of sensorium (especially in older patients) as well as respiratory depression. Modern strategies to control postoperative pain involve a multimodal approach that includes the use of intravenous patient-controlled analgesia.