Anesthesia and Analgesia Practices in Total Joint Arthroplasty: A Survey of the AAHKS Membership

Abstract Background The purpose of this study was to survey the current analgesia and anesthesia practices used by total joint arthroplasty surgeon members of the American Association of Hip and Knee Surgeons (AAHKS). Methods A survey of 28 questions was created and approved by the AAHKS Research Committee. The survey was distributed to all 2,208 board certified adult reconstruction surgeon members of AAHKS in November 2018. Results There were 622 responses (28.2%) to the survey. A majority of respondents (93.2%, n=576) use preemptive analgesia prior to total joint arthroplasty (TJA). Most respondents use a spinal for total knee arthroplasty (TKA) (74.4%) and for total hip arthroplasty (THA) (72.6%). A peripheral nerve block is routinely used by 68.7% of respondents in primary TKA. Periarticular injection or local infiltration anesthesia is routinely used by 80.3% of respondents for both TKA and THA patients. The average number of opioid pills prescribed postoperatively after TKA is 49 pills (range 0 – 200) and after THA is 44 pills (range 0 – 200). Most surgeons (58%) expect this prescription should last for 2 weeks. A majority of respondents (74.0%) use multimodal analgesics in addition to opioids. Conclusion There is no consensus regarding the optimal multimodal anesthetic and analgesic regimen for TJA among surveyed board certified arthroplasty surgeon members of AAHKS. Understanding current practice patterns in anesthesia, analgesia, and opioid prescribing may serve as a platform for future work aimed at establishing best clinical practices of maximizing effective postoperative pain control and minimizing the risks associated with prescribing opioids.