CME expires July 31, 2028

Go beyond traditional learning with a 360° perspective on orthopedic topics.

Each ICL360 is a cutting-edge CME course designed to provide a holistic learning experience, featuring curated video content sourced from expert-selected Instructional Course Lectures enhanced with insightful commentary and comprehensive assessment questions. This all-encompassing course goes beyond traditional learning by offering a complete 360° perspective on orthopedic topics. Explore additional resources, including full-text readings from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), technique videos from Orthopaedic Video Theater (OVT), and links to external literature and PubMed. Elevate your clinical decision-making skills and gain a well-rounded understanding of essential orthopedic concepts with ICL360.

This Instructional Course Lecture (ICL) examines current strategies for perioperative and postoperative pain management in patients undergoing total hip or knee arthroplasty.

Editor
Liz Dailey, MD, FAAOS 

Learning Objectives

• Evaluate the efficacy of multimodal analgesia protocols in total joint arthroplasty to optimize pain control and reduce opioid consumption.
• Differentiate between spinal and general anesthesia in total joint arthroplasty, considering current evidence on outcomes, such as opioid use, intensive care unit admissions, and early ambulation.
• Apply the latest clinical practice guidelines to design a multimodal perioperative pain management protocol, incorporating acetaminophen, NSAIDs, corticosteroids, and regional nerve blocks, tailored to patient-specific factors to improve postoperative outcomes.
• Assess the appropriate use and safety profiles of gabapentinoids in total joint arthroplasty, with a focus on opioid-sparing effects versus risks, such as respiratory depression and sedation.
• Effectively incorporate periarticular injections by selecting appropriate agents (eg, bupivacaine, corticosteroids, ketorolac) and understanding their pharmacologic synergy and complication profile.
• Use selective serotonin reuptake inhibitors, particularly duloxetine, in select patients with high pain catastrophization or neuropathic pain features based on current meta-analytic evidence.
• Critically appraise the role of genicular nerve radiofrequency ablation in the management of pain after total knee arthroplasty, distinguishing between perioperative and chronic applications.
• Implement opioid stewardship strategies preoperatively and postoperatively by educating patients, tapering chronic users, and minimizing discharge prescriptions.
• Compare the effects of adductor canal blocks, interspace between the popliteal artery and the capsule of the posterior knee blocks, and genicular nerve blocks on functional recovery and opioid use in patients undergoing total knee arthroplasty.

Earn up to 5 AMA PRA Category 1 CME credits™.