Intra-articular injection of drugs to reduce bleeding and manage postoperative pain is an established procedure for which a variety of protocols and drugs are available (Ranawat and Ranawat 2007; Kelley et al. 2013; Mullaji et al. 2010) (Table 14.2). Numerous studies have shown that local anesthetic infiltration can reduce pain and bleeding for about 4 h during the postoperative period and the need for analgesic drugs for 4 weeks postoperatively. Its effectiveness is directly related to the injection technique, which should be performed before and then again after prosthesis positioning (Ranawat and Ranawat 2007) in the intra- and extra-articular regions. The right execution allows a significant improvement of postoperative pain and a better functional recovery (Ranawat and Ranawat 2007).

Maintenance of postoperative infusion therapy is essential for good pain management during the postoperative period. The use of morphine alone has been generally abandoned because of the numerous complications associated with the administration of high doses. Under one of the commonly used protocols, combination therapy involves continuous infusion of several different drugs at different times to create a synergistic effect between them, with optimal pain control and fewer side effects (Dalury et al. 2011).

The recent literature shows that multimodal analgesia allows a better pain control than PCA (Lamplot et al. 2014).

Analgesic therapy prescribed at discharge should be selected by the anesthesiologist and should consider the following aspects:

Aggressive analgesic therapy is essential for ensuring patient satisfaction and accelerating rehabilitation and joint function recovery. Patients who have received aggressive continuous analgesic therapy have reported significantly better postoperative improvement than those who used analgesics only as needed (Pati et al. 1994).