The use of the pain pump and patient-controlled analgesia in joint reconstruction.

Controlling postoperative pain following painful orthopedic procedures such as total knee arthroplasty is an ongoing challenge, as current pain management techniques often result in undermedication and/or complications. Traditional pain management strategies include opioid analgesics administered orally or via epidural catheter, patient-controlled analgesia (PCA), or intramuscular (IM) injection. This article discusses the use of PCA and the pain pump as effective modalities for the management of pain after arthroplasty. While the use of PCA has been somewhat controversial, a review of the literature supports its use over traditional IM dosing. PCA has been shown to provide more effective analgesia than IM dosing, and PCA administration is preferred over IM dosing by both patients and nurses. Continuous infusion of bupivacaine via pain pump is also an effective modality for reducing postoperative pain and decreasing postoperative consumption of opioid analgesics.