pain, Dr. Joshi is in favor of telling patients up front to expect
"an acceptable" amount of pain, and that reporting a higher pain
score won't automatically translate to them receiving more opi-
oids.
"We have to define the acceptable level of pain for patients —
they should be able to function, maybe walk around a little bit,"
he says. "The plan should be to reduce pain to that acceptable
level." — Kendal Gapinski
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respiratory depression are established — particularly if combined
with an opioid.
"Total knee arthroplasty is highly amenable to long-lasting regional
analgesia techniques," she says. "We may find a ceiling effect, whereby
individual agents like gabapentin do not have additional benefits on
pain control over and above those produced with effective nerve blocks
plus acetaminophen and NSAIDs."
Moving closer to zero
Dr. Joshi notes that although the overall goal is to reduce the use of
opioids, you still will likely need to include some in the multimodal
regimen for total knee patients. The key is to make sure they're not
overprescribed, which was one of the causes of the opioid epidemic.
Instead, be sure your providers are choosing the lowest dose for the
shortest duration possible.
Drs. Joshi and Soffin agree that reducing the overall number of opi-
oids prescribed after surgery requires educating patients on your
expectations for their post-op recoveries and establishing realistic
expectations of the pain they'll experience.
"Patients need to have a realistic approach to surgery," says Dr.
Joshi. "They should know that some pain is normal, and that it will
