CASE: Pain control after total knee arthroplasty (TKA) remains a significant challenge, especially in the context of certain patient-specific factors. We present a case of a 59-year-old woman with opioid-induced hyperalgesia who was referred for left knee pain and end-stage tricompartmental degenerative joint disease after failure of conservative management. We outline an approach to control postoperative pain in patients undergoing TKA who have severe opioid contraindications. CONCLUSIONS: TKA and rehabilitation with a 6-year follow-up period was accomplished using a multimodal nonopioid approach, consisting of a combination of gabapentin, acetaminophen, ketorolac, meloxicam, methocarbamol, a tunneled femoral nerve catheter, and periarticular injection.
CASE: Pain control after total knee arthroplasty (TKA) remains a significant challenge, especially in the context of certain patient-specific factors. We present a case of a 59-year-old woman with opioid-induced hyperalgesia who was referred for left knee pain and end-stage tricompartmental degenerative joint disease after failure of conservative management. We outline an approach to control postoperative pain in patients undergoing TKA who have severe opioid contraindications. CONCLUSIONS: TKA and rehabilitation with a 6-year follow-up period was accomplished using a multimodal nonopioid approach, consisting of a combination of gabapentin, acetaminophen, ketorolac, meloxicam, methocarbamol, a tunneled femoral nerve catheter, and periarticular injection.