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 |