Speaker: Recent changes in TJA pain management offer some key advantages

LAS VEGAS — The recent addition of peri-articular injections, adductor canal blocks and continuous infusion pumps to the pain management options for total joint arthroplasty provides advantages for patients and orthopedic surgeons alike, a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting said in a quick overview he gave of some newer pain management approaches.

“In the hip and knee world, we’ve seen a significant evolution in our approach to pain management over the last 4 decades,” Henry D. Clarke, MD, of Mayo Clinic in Phoenix, said.

He noted some of these newer pain management options may eventually play a role in moving more TJA cases to the outpatient setting.

“Over the past 5 to 10 years, we’ve seen peri-articular injections supplant peripheral nerve blocks, chiefly because they avoid the downsides, which are things like falls and motor inhibition, without affecting pain for most patients,” Clarke said.

Adductor canal blocks (ACBs) used either alone or in addition to peri-articular injections, are showing promise, he noted.

However, there are conflicting results regarding the use of these blocks, Clarke said, explaining that one study showed no difference when ACBs were added to peri-articular injections for pain management.

However, the opposite result occurred in another study in which investigators found modest improvement in opioid use and the total burden of pain during patients’ hospital stay.

According to Clarke, continuous infusion pain pumps are also appealing, particularly from the standpoint that these will help orthopedic surgeons move more of their patients undergoing arthroplasty to the outpatient setting.

“I think adductor canal blocks seem to offer benefit to some patients. We need more information about continuous infusion pumps,” Clarke said. – by Susan M. Rapp

Reference:

Clarke HD. Flash Five: What’s coming down the pike? Presented at: American Academy of Orthopaedic Surgeons; March 12-16, 2019; Las Vegas.

Disclosure: Clarke reports he receives IP royalties from and is paid consultant for Biomet; receives IP royalties from and is a paid and unpaid consultant for ConforMIS; is an unpaid consultant for OSSO VR; is a paid consultant and paid presenter or speaker for Smith & Nephew; receives research support from Stryker and Teleflex/Vidacare; and receives IP royalties from and is a paid consultant for Zimmer.