Use and Impact of Multimodal Analgesia in Total Joint Arthroplasty


Multimodal analgesia is thought to improve postsurgical recovery. In this analysis we assess the use of multimodal analgesia in total knee arthroplasty (TKA) and total hip arthroplasty (THA) and its impact on perioperative outcomes.


Patients undergoing TKA and THA were identified in the Premier Perspective Hospital Database from July 1, 2013 to March 31, 2015. Those receiving multimodal analgesia (combination of bupivacaine liposomal injectable suspension (BLIS), intravenous acetaminophen, and ketorolac) were compared to those who did not. Propensity scores were used to match patients on age, gender, race, Charlson comorbidity index, payer, region, hospital teaching status, and length of surgery. Outcomes included hospital length of stay (LOS), proportion discharged in ? 2 days, home discharge, and readmission to the same hospital.


A total of 145,288 patients (95,296 TKA and 49,992 THA) were identified during this period; only 7.6% of TKA patients (7,242) and 4.1% of THA patients (2,050) received multimodal analgesia, while 22.3% of TKA patients (21,251) and 29.5% of THA patients (14,748) did not receive any of the three medications of interest. The final analysis included 6,600 matched pairs for TKA and 2,037 matched pairs for THA. Compared to controls, patients who received multimodal analgesia had a shorter LOS for both TKA (mean 2.52 vs 3.08 days, p< 0.001) and THA (mean 2.45 vs 3.04 days, p< 0.001), were more likely discharged in ? 2 days for both TKA (56.5% vs 25.4%, p< 0.001) and THA (62.7% vs. 38.8%, p< 0.001), and a higher proportion were discharged home for both TKA (75.9% vs. 65.5%, p< 0.001) and THA (80.3% vs. 69.2%, p< 0.001).


The use of multimodal analgesia combining a long-acting local analgesic, non-opioid analgesic, and non-steroidal anti-inflammatory may be underutilized in patients undergoing TKA and THA, despite the potential benefits of this approach on important perioperative outcomes including LOS and discharge home.

AuthorsJ Aggarwal, SH Park, S Dagenais, A Kang, J Menzin
JournalValue in Health
Therapeutic AreaOther
Service AreaModeling & Meta-Analysis
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