The Perioperative Management of Partial Knee Arthroplasty: Anesthesia, Pain Management, and Blood Loss

Pain is the body’s physiological reaction to tissue injury and involves nociceptive, inflammatory, and ischemic phenomena. Inflammation can lead to peripheral and central pain sensitization. The extent of this pain will depend on both phenotype and genotype of the patient. The following chapter discusses the advantages of unicompartmental knee arthroplasty (UKA) to reduce pain and blood loss after knee arthroplasty. Optimizing pain management starts with preemptive and preventive analgesia. Today’s modern pain control consists of multimodal pain management by combining different drugs and anesthetic techniques with different mechanisms of action. Most often, acetaminophen and NSAIDs are used with morphine only for breakthrough pain. The latter should be limited as much as possible because of its side effects. Local infiltration analgesia (LIA) or adductor canal blockade is used most commonly to reduce peripheral sensitization. Unicompartmental knee arthroplasty, which is less invasive, will help reduce the intensity of the postoperative pain. Optimizing blood management has the aim to reduce or eliminate blood transfusion. UKA reduces blood loss by its surgical technique, but a multimodal approach is indicated here also. Preoperative hemoglobin optimization, preoperative bleeding risk assessment and bridging strategy, the use of tranexamic acid, and the local hemostatic effect of LIA with the adrenergic properties of ropivacaine should all be part of this multimodal program. Multimodal pain strategies and blood management protocols have proven value after total knee arthroplasty. The same protocols can logically be applied to patients undergoing UKA. Patients undergoing UKA today can expect excellent pain relief, low morbidity, and rapid recovery when advanced pain and blood management protocols are employed