RT Journal
A1 Dalury, David F.
A1 Lieberman, Jay R.
A1 MacDonald, Steven J.
T1 Current and Innovative Pain Management Techniques in Total Knee Arthroplasty
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2011
FD October 19
VO 93
IS 20
SP 1938
OP 1943
DO 10.2106/JBJS.9320icl
UL http://dx.doi.org/10.2106/JBJS.9320icl
AB 
Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”1 It is of considerable concern to patients undergoing total knee replacement because the procedure has the reputation of being extremely painful, and fear of this pain is frequently cited as a reason for delaying the decision to undergo surgery2. Postoperative pain is intensified by movement and has a circadian rhythm with increasing pain at night3. Failure to adequately control pain following total knee replacement induces pathophysiologic responses, which increase postoperative morbidity, hinder physiotherapy, increase anxiety, disrupt sleep patterns, and, in general, decrease patient satisfaction and recovery. Patients believe that physicians do not fully appreciate the need for perioperative pain management, and this adds to patient anxiety. Surgeons need to recognize the importance of managing pain. In addition, the Joint Commission on Accreditation of Healthcare Organizations has declared pain to be the “fifth vital sign” and acknowledged that patients have a “right” to adequate pain management4.