Multimodal Analgesia in Orthopedic Surgery

Multimodal analgesia integrates distinct pharmacological and regional techniques to target multiple pathways of pain transmission, thereby improving perioperative comfort and minimising reliance on opioids. In orthopaedic procedures such as joint arthroplasty, fracture fixation and ligament reconstruction, surgical trauma triggers nociceptive, inflammatory and neuropathic components of pain. By combining systemic agents—including non‐steroidal anti‐inflammatory drugs, acetaminophen, gabapentinoids and judicious opioids—with regional approaches such as peripheral nerve blocks and local infiltration, clinicians can achieve more consistent analgesia, reduce adverse effects and facilitate early mobilisation. Enhanced recovery protocols increasingly embed multimodal strategies to shorten hospital stays, diminish postoperative morbidity and promote functional rehabilitation. Key challenges remain in defining optimal drug combinations, timing of administration and individual patient factors such as comorbidities and risk of falls. Ongoing research seeks to refine dose regimens, compare novel long‐acting formulations and integrate perioperative care pathways to ensure safe, effective and cost‐efficient pain management across diverse orthopaedic settings.

Research from Nature Portfolio

Meta-analytic work has confirmed that adductor canal block achieves equivalent pain control to femoral nerve block while preserving quadriceps strength and enhancing early knee function. Analysis across randomised trials demonstrated that patients receiving sensory‐selective blockade maintained higher muscle contraction without increased opioid consumption or complications, translating into faster ambulation and lower fall risk. These findings have underpinned updates to regional analgesia guidelines, emphasising the role of targeted sensory blocks in contemporary total knee arthroplasty protocols.

Multimodal Analgesia in Orthopedic Surgery publication trend

The graph below shows the total number of articles in multimodal analgesia in orthopedic surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Multimodal analgesia: Use of multiple analgesic agents and techniques to target different pain pathways and reduce opioid use.

Peripheral nerve block: Injection of local anaesthetic near a specific nerve to interrupt pain signals from a defined region.

Local infiltration analgesia: Peri- or intraarticular injection of a mixture of local anaesthetics and adjuncts into surgical tissues.

Adductor canal block: Sensory-selective nerve block of the saphenous branch within the adductor canal, sparing quadriceps strength.

Femoral nerve block: Regional blockade of the femoral nerve providing dense analgesia to the anterior thigh and knee but with potential motor weakness.

Liposomal bupivacaine: Extended-release formulation of bupivacaine encapsulated in liposomes for prolonged local anaesthetic effect.

References

1. Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. Scientific Reports (2017).
2. Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023. British Journal of Anaesthesia (2023).
3. A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty. Arthroplasty (2024).
4. Femoral nerve block using lower concentration ropivacaine preserves quadriceps strength while providing similar analgesic effects after knee arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy (2023).