The Journal of Bone and Joint Surgery - Current Concepts Review: 07 July 2021 - Volume 103 - Issue 17 - p. 1652-1662

An Update on Multimodal Pain Management After Total Joint Arthroplasty

Karam, Joseph A., MD; Schwenk, Eric S., MD; Parvizi, Javad, MD, FRCS

Hip Knee

Multimodal analgesia has become the standard of care for total joint arthroplasty as it provides superior analgesia with fewer side effects than opioid-only protocols.
Systemic medications, including nonsteroidal anti-inflammatory drugs, acetaminophen, corticosteroids, and gabapentinoids, and local anesthetics via local infiltration analgesia and peripheral nerve blocks, are the foundation of multimodal analgesia in total joint arthroplasty.
Ideally, multimodal analgesia should begin preoperatively and continue throughout the perioperative period and beyond discharge.
There is insufficient evidence to support the routine use of intravenous acetaminophen or liposomal bupivacaine as part of multimodal analgesia protocols.