Current Concepts Review   |    
Multimodal Pain Management After Total Joint Arthroplasty
Javad Parvizi, MD, FRCS1; Adam G. Miller, MD1; Kishor Gandhi, MD2
1 Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for J. Parvizi: research@rothmaninstitute.com
2 Department of Anesthesiology, Thomas Jefferson University, 111 South 11th Street, Suite 6201, Philadelphia, PA 19107
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Stryker Orthopaedics, Biomet, and SmarTech).

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Investigation performed at Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jun 01;93(11):1075-1084. doi: 10.2106/JBJS.J.01095
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Adequate postoperative pain control in patients who have undergone total joint arthroplasty allows faster rehabilitation and reduces the rate of postoperative complications.

Multimodal pain management involves the introduction of adjunctive pain control methods in an attempt to control pain with less reliance on opioids and fewer side effects.

Current research suggests that traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and the associated cyclooxygenase type-2 (COX-2) inhibitors improve pain control in most cases.

Nearly all multimodal pain management modalities have a safe side-effect profile when they are added to existing methods. The exception is the administration of DepoDur (extended-release epidural morphine) to elderly or respiratory-compromised patients because of a potential for hypoxia and cardiopulmonary events.

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