Post operative analgesia options for Total Knee Replacement

We, at the pain service understand the post operative analgesia demands

of post TKR patients. There is a need for intense analgesia at time of

physiotherapy and early ambulation in the post operative period.

The following analgesia plans are available for TKR patients-

Epidural continuous infusion of local anesthetics with or without

opioid.

Patient controlled epidural using local anesthetics with or without

opioid.

Patient controlled intravenous analgesia using injection Morphine

Patient controlled intravenous analgesia using injection Tramadol

Epidural continuous infusion of local anesthetics with or without

opioid

The local anesthetic solution is given in the epidural space by means of

specialised pumps, either the disposable elastomeric pumps or syringe

infusion pumps.

The concentration used is 0.125% injection marcaine plain or for patients in

the ICUs 0.1% injection marcaine with opiod.

The epidural infusion is usually continued for 3 days post operatively and

patients can be allowed to mobilise with support if they are not feeling

excessive motor blockade, in which case the concentration of local

anesthetic can be decreased, or the infusion can be switched off half an

hour before the intended time of mobilization.

Patient controlled epidural using local anesthetics with or without

opioid ( PCEA)

Same drug solutions as above but the pump used allow the patient to self

administer a dose of local anesthetic, via the epidural catheter , to give the

patient better control over their own pain and allow smoother

physiotherapy.

Patient satisfaction is improved and there is less demands for supplemental

analgesia.

The demand dose, basal rate and lockout interval is adjusted according to

patients age, medical condition and demand of physiotherapy.

Patient controlled intravenous analgesia (PCA) using injection

Morphine or Tramadol (Tramal)

Injection morphine/ tramadol is administered using PCA pumps. There is a

small basal rate to allow patient comfort and the patient can self administer

extra doses of the opioid at time of pain, eg during physiotherapy or

mobilization.

The concentration of injection morphine used is 1mg/ml, and that of

injection tramadol is 10mg/ml.

The demand dose, basal rate and lockout interval is adjusted according to

patients age, medical condition and demand of physiotherapy.

Capsule tramadol is not prescribed while the patient is on PCA tramadol.

General information

All patients on the pain service are followed up 3 times a day. Most of the

analgesia plans are continued for 3-4 days and after this period the oral

co-analgesics are continued.

The possible drug related side effects are anticipated (for example- nausea,

vomiting and constipation) and appropriate orders are written in the patient

medication chart to manage them.

There are also orders for rescue analgesics to manage any breakthrough

pain. All patients are prescribed regular co analgesics in the form of oral

tramadol, paracetamol, and NSAID s as appropriate.

Dr Farah Jafri

Pain Team

Al Razi hospital