Game changers in pain management: Periarticular injections

Research output: Contribution to journalArticlepeer-review


Periarticular injection (PAI) of anesthetics is an important and effective component of multimodal pain therapy in total knee arthroplasty, which as been extensively reported and supported in the literature. The existing data supports that liposomal bupivacaine is an effective PAI that can be used to provide comparable pain relief to that achieved by regional blocks. However, liposomal bupivacaine has not been shown to provide superior pain relief when compared to traditional ropivacaine or bupivacaine PAI's in multimodal pain protocols after TKA. Further, liposomal bupivacaine is prohibitively priced at approximately six times that of ropivacaine-based PAI cocktails. Therefore, the “game changer” is the implementation of periarticular injections as an essential component of multimodal pain control programs and NOT liposomal bupivacaine as the ingredient. Finally, it is likely that preoperative education focused on expectation management combined with a multimodal pain protocol are the most effective strategies for controlling pain and optimizing outcomes after TKA.

Original languageEnglish (US)
Pages (from-to)50-52
Number of pages3
JournalSeminars in arthroplasty
Issue number2
StatePublished - Jun 2017


  • Bupivacaine
  • Liposomal bupivacaine
  • Pain control
  • Periarticular injection
  • Total knee arthroplasty

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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