Not recommended for Total Knee Arthroplasty

 

Pre-operative

Not recommended

·         Systemic analgesia:

       Alpha-2-delta subunit ligands (gabapentinoids)

       Conventional NSAIDs Corticosteroids (may be used for reasons other than postoperative analgesia)

       NMDA antagonists (dextromethorphan and ketamine)

       Strong opioids

·         Peripheral nerve blocks:

       Combination femoral and obturator block

       Combination femoral and sciatic nerve block

       Lumbar plexus block (posterior approach)

       Clonidine, as part of the LA solution in peripheral nerve blocks

·         Epidural:

       LA and/or opioid not recommended for routine use

       Ketamine and tramadol (as adjuvants to epidural)

·         Spinal:

       Neostigmine

       Clonidine

·         Intra-articular techniques

·         Physical therapy (based on postoperative analgesic effects alone)

Intra-operative

Not recommended

·         Systemic analgesia:

       NMDA antagonists (dextromethorphan and ketamine)

        Weak opioids

·         Peripheral nerve blocks administered intra-operatively

·         GA without any local or regional analgesic technique

·         Epidural anaesthesia for routine use

·         Intra-articular techniques

·         Drains

Postoperative

Not recommended

·         Systemic analgesia:

       Alpha-2-delta subunit ligands (gabapentinoids)

       Peri-operative clonidine

       IV Ketamine infusion

       IM Strong opioids

       Weak opioids (for high intensity pain)

       Paracetamol (for high intensity pain)

·         Peripheral nerve blocks:

       Combination femoral and obturator block

       Combination femoral and sciatic nerve block

       Lumbar plexus block (posterior approach)

       Clonidine, as part of the LA solution in peripheral nerve blocks

·         Epidural:

       LA and/or opioid not recommended for routine use

       Ketamine and tramadol (as sdjuvants to epidural)

·         Intra-articular techniques

·         TENS

·         Cooling and compression techniques