PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
TKA is a major orthopaedic procedure associated with significant postoperative pain that is difficult to treat, and which may lead to persistent pain in 15 to 20% of patients (Grosu 2014; Wylde 2018). Effective pain control is essential for rehabilitation and to enhance recovery and long-term outcomes.
The aim of this PROSPECT review is to provide clinicians with recommendations for pain management after unilateral primary TKA, with particular attention to early rehabilitation and mobilisation.
This narrative review is based on published systematic reviews and meta-analyses, using modified PROSPECT methodology (details in the full publication: Lavand’homme 2022). It updates the previous review (Fischer 2008).
The PROSPECT approach is unique in that the available evidence is critically assessed for current clinical relevance, balanced with regards to the use of simple non-opioid analgesics, such as paracetamol and NSAIDs. This approach reports true clinical effectiveness by balancing the invasiveness of the analgesic interventions and the degree of pain after surgery, and also balancing efficacy and adverse effects. In addition, attention is paid to early rehabilitation and mobilisation.
ACB, adductor canal block; COX, cyclooxygenase; IV, intravenous; LIA, local infiltration analgesia; NSAIDs, non-steroidal anti-inflammatory drugs; PONV, postoperative nausea and vomiting; RCT, randomised controlled trial; TKA, total knee arthroplasty.
COX, cyclooxygenase; NSAIDs, non-steroidal anti-inflammatory drugs.
Analgesic interventions that are not recommended for pain management following primary TKA.
IV, intravenous; TENS, transcutaneous electrical nerve stimulation.
COX, cyclooxygenase; IV, intravenously, NSAIDs, non-steroidal anti-inflammatory drugs.