ABSTRACT
Patients who undergo total joint arthroplasty experience significant postoperative pain. Failure to provide adequate analgesia impedes aggressive physical therapy and rehabilitation, which is critical to maintaining joint range of motion, and potentially delays hospital dismissal. Traditionally, analgesia after total joint replacement was provided by either intravenous patient-controlled analgesia or epidural analgesia. However, each technique has distinct advantages and disadvantages. For example, opioids do not consistently provide adequate pain relief and often cause sedation, constipation, nausea or vomiting, and pruritus. Epidural infusions containing local anesthetics (with or without an opioid) provide superior analgesia but are associated with hypotension, urinary retention, motor block that limits ambulation, and hematoma due to anticoagulation.
