Home > Journals > Minerva Anestesiologica > Past Issues > Minerva Anestesiologica 2018 December;84(12) > Minerva Anestesiologica 2018 December;84(12):1406-12

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as

 

EXPERTS’ OPINION   Freefree

Minerva Anestesiologica 2018 December;84(12):1406-12

DOI: 10.23736/S0375-9393.18.12383-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Anesthesia and analgesia for total knee arthroplasty

Ellen M. SOFFIN , Stavros G. MEMTSOUDIS

Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA



The demand for total knee arthroplasty (TKA) is rising worldwide. Controversy persists in the literature regarding the benefits of general versus neuraxial anesthesia and which anesthetic is associated with the best outcomes. Likewise, the abundance of analgesic options for post-TKA pain have led to debate regarding the safest, most effective regimens. In this paper, we evaluated a selection of recent publications regarding anesthetic and analgesic choices for TKA. High-quality studies and meta-analyses linking anesthetic agents and analgesic modalities to clinically important outcomes were chosen wherever possible. We included a range of clinical and population-based research, incorporating established and emerging techniques. Although not uniform, clinical and population-based data favor neuraxial anesthesia, and suggest less morbidity compared to general anesthesia. There is good evidence to support an opioid-minimizing, multimodal approach to post-TKA analgesia, featuring peripheral nerve blocks and/or peri-articular injection. The recently described IPACK (interspace between the popliteal artery and posterior capsule of the knee) block may address posterior knee pain after TKA. Ultrasound-guided regional analgesia techniques are cost and clinically effective. Liposomal bupivacaine represents an expanding topic of research in TKA-analgesia, but currently, data do not support routine use. Evidence to guide the creation of pathways of care for TKA abounds, but must be tailored to local practice to maximize chances of success. Recent data supports the use of neuraxial anesthesia and regional analgesia techniques for TKA. Recommendations for clinical practice and future research to improve the state of the art are provided.


KEY WORDS: Knee replacement arthroplasty - Epidural anesthesia - Spinal anesthesia - Nerve block

top of page