John E. Tetzlaff

A review of the mechanisms of acute pain and treatment strategies in orthopedic patients with special emphasis on pre-emptive analgesia. Acute pain after orthopedic surgery should be anticipated and its treatment should be a part of every anesthetic plan. Analgesic approaches have changed in recent years in part due to patient expectations, the shift toward ambulatory surgery, and shorter hospital stays. Further, analgesic options have increased with new drugs and modes of delivery.

Postoperative pain control after surgery of the joint can be obtained through the use of intraarticular injection of local anesthetics and opioids. The observation that patients who had arthroscopic knee surgery under local anesthesia seem to have less postoperative pain than patients with comparable procedures performed under general anesthesia lead to investigations to explain this phenomenon.

Insufficiently-treated severe acute pain has been observed to have multifactorial, deleterious effects — direct and indirect — on the cardiovascular system. Acute nociceptive pain is a signal of tissue injury and perception is initially adaptive, causing an organism to take steps to decrease the tissue damage. In other words, the ability to sense pain is basically a protective mechanism.