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Background <p>Postoperative pain after arthroscopic and joint surgical procedures affects mobilization, sleep quality, rehabilitation, patient satisfaction, discharge readiness and the chronification of postoperative pain. Modern concepts therefore combine nonopioid analgesics, regional anesthesia, local infiltration analgesia, structured pain assessment and a&#xa0;defined rescue strategy rather than relying on opioid-centered concepts alone. The aim of the article is a&#xa0;practical review of modern multimodal pain pathways in joint surgery with focus on the Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI)-oriented perioperative concepts.</p> Material and methods <p>Narrative review including German-language guidelines, ÖGARI recommendations, the Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines on acute pain, enhanced recovery after surgery (ERAS) recommendations and PROSPECT recommendations for hip and knee arthroplasty.</p> Results <p>An effective perioperative analgesia should be procedure-specific, functional and opioid-sparing. Paracetamol, nonsteroidal anti-inflammatory drugs (NSAID) or COX-2&#xa0;inhibitors, dexamethasone, regional anesthesia, local infiltration analgesia and clearly structured postoperative follow-up represent core elements. Opioids remain an important rescue medication but should be used for the shortest possible duration and preferably in immediate-release formulations. Hydromorphone can be useful for selected patients but requires a strict benefit-risk assessment.</p> Conclusions <p>Modern perioperative pain management in joint surgery is pathway medicine focusing not on pain relief at any cost but on functional recovery, safe analgesia, early mobilization and minimization of opioid-related adverse effects.</p>

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Perioperatives und multimodales Schmerzmanagement in der Gelenkchirurgie

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Markus F. Luger

摘要

Background

Postoperative pain after arthroscopic and joint surgical procedures affects mobilization, sleep quality, rehabilitation, patient satisfaction, discharge readiness and the chronification of postoperative pain. Modern concepts therefore combine nonopioid analgesics, regional anesthesia, local infiltration analgesia, structured pain assessment and a defined rescue strategy rather than relying on opioid-centered concepts alone. The aim of the article is a practical review of modern multimodal pain pathways in joint surgery with focus on the Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI)-oriented perioperative concepts.

Material and methods

Narrative review including German-language guidelines, ÖGARI recommendations, the Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines on acute pain, enhanced recovery after surgery (ERAS) recommendations and PROSPECT recommendations for hip and knee arthroplasty.

Results

An effective perioperative analgesia should be procedure-specific, functional and opioid-sparing. Paracetamol, nonsteroidal anti-inflammatory drugs (NSAID) or COX-2 inhibitors, dexamethasone, regional anesthesia, local infiltration analgesia and clearly structured postoperative follow-up represent core elements. Opioids remain an important rescue medication but should be used for the shortest possible duration and preferably in immediate-release formulations. Hydromorphone can be useful for selected patients but requires a strict benefit-risk assessment.

Conclusions

Modern perioperative pain management in joint surgery is pathway medicine focusing not on pain relief at any cost but on functional recovery, safe analgesia, early mobilization and minimization of opioid-related adverse effects.