Instructional course lectures
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The decision to use regional or general anesthesia for patients undergoing total joint arthroplasty continues to be controversial. Recent reviews of the literature support the growing trend for the use of regional anesthesia with a multifaceted approach, spanning nuances in block placement as well as pharmacologic agents and delivery systems. Innovative developments offer appealing options and encouraging results for the management of pain after major orthopaedic procedures. The ultimate decision, although varied, requires careful preoperative planning and protocols to ensure adequate pain control and patient satisfaction.
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Theoretically, an appropriately designed and implemented multimodal pain protocol should reduce postoperative pain levels, need for narcotic medication, and adverse events while improving functional recovery including ambulation, discharge from hospital, range of motion, and return to work. A complete, perioperative multimodal pain protocol for total hip replacement and total knee replacement, including use of a novel periarticular injection, has been described and early clinical results are reported.