Comprehensive Analysis of Pain Management after Total Knee Arthroplasty.

Total knee arthroplasty (TKA) has been much improved recently and it is regarded as one of the most common and successful surgical procedures that provides pain relief and improves function in patients with severe knee arthritis. However, recent studies have reported that 15%-20% of patients are not satisfied after TKA without evident clinical or radiological findings and the most common causes of patient dissatisfaction include residual pain and limited function. The evaluation and treatment of painful TKA relies on a thorough understanding of the origin by careful evaluation, and a systematic approach is essential to efficiently and effectively resolve the pain. Periarticular injections (PAIs) and nerve blocks are gaining popularity because they are associated with less side effects than systemic regimens. The analgesic efficacy and safety of PAI compared with nerve blocks for postoperative pain management still remain controversial. Therefore, more study is needed to determine if any changes in the regimen of the injection or technique could provide added benefit to long-term functional improvement beyond the perioperative period.