Efficiency of the multimodal approach to analgesia in total knee arthroplasty

MATERIAL AND METHODS: The study included 160 patients with end stage knee osteoarthritis hospitalized for primary uncomplicated TKA. There were 142 women and 18 men (mean age 66.5 and 65.4 years respectively). In the control group (n=100) standard protocol of perioperative pain management was applied, in the main group (n=60) - original multimodal approach including patient's education in order to increase his awareness and to reduce anxiety on the preoperative stage, modified surgical technique (optimization of incision length, 'sliding window' principle, tourniquet during the whole procedure until applying of compressive dressing, no drains and local infiltration analgesia) and double-level postoperative analgesia. Different factors of pain syndrome were assessed before surgery by using of specialized tests, while the dynamics of early postoperative pain characteristics were evaluated by individual diaries. RESULTS: Despite decrease of pain syndrome in both groups within 3 days after TKA in the main group these changes were significantly better (p<0.05). On the first postoperative day 42 (70%) patients in the main group had not pain at rest, while in the control group such cases were absent (р<0.001). There was 2-fold increase of hours of moderate/severe pain per day in the control group compared with the main group (р<0.001). No specific complications were identified in both groups during follow-up. CONCLUSION: Original multimodal perioperative approach to analgesia proved its efficiency in patients undergoing primary TKA compared with conventional one and may be safely used in clinical practice.