age the post-op pain of total knee patients and reduce their risk of
long-term opioid dependence, but you don't need to totally eliminate
the use of opioids to enhance recoveries. Focus on opioid-sparing
techniques instead of trying to eliminate their use altogether, suggests
Girish P. Joshi, MBBS, MD, FFARCSI, a professor of anesthesiology
and pain management at the University of Texas Southwestern
Medical Center in Dallas.
"Studies have shown that the judicious use of intraoperative opioids
can be beneficial to a multimodal pain management plan," he says. "The
primary aim is to use less opioids than you used before."
Accomplishing that goal requires your anesthesia team to target and
block sensory nerves and administer non-opioid analgesic agents.
Longer-lasting comfort
Several years ago, providers learned to reduce pain after total knee
arthroplasty for the initial 24 hours post-op through the use of peripheral
nerve blocks, local infiltration analgesia and multimodal pain relief. "But
when the blocks wore off, patients were uncomfortable, and often had
sudden high requirements for opioids to treat breakthrough pain," says
Dr. Soffin.
Now, the goal is to find ways to take these techniques to the next
level by extending the duration of pain relief without the use of opi-
oids.
"One solution has been to add an adjuvant, like steroids, to local
anesthetics," says Dr. Soffin. "Extended duration formulations of local
anesthetics are also increasingly being applied to total knee arthro-
plasty, but their cost relative to outcome benefits remains to be fully
established."
She points out that cooled radiofrequency ablation techniques have
emerged as a potential option to denervate sensory nerves supplying
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