Joint replacement used to mean a heavy reliance on opioid painkillers after surgery. Modern protocols have moved away from that — not by tolerating more pain, but by controlling it through several complementary methods at once, so no single drug has to do all the work.
Why minimise opioids in the first place?
Opioids are effective for acute pain, but they carry real downsides: nausea, constipation, drowsiness that delays mobilisation, and a risk of prolonged use beyond the surgical recovery period. Since early walking is one of the strongest predictors of a smooth joint replacement recovery, anything that keeps a patient too drowsy or nauseated to get up and move works against the goal of the surgery itself.
What a multimodal, opioid-sparing protocol includes
- Regional nerve blocks: A targeted local anaesthetic block numbs the surgical area for many hours, reducing pain right from the point you wake up.
- Local infiltration analgesia: Long-acting local anaesthetic is infiltrated directly around the joint during surgery.
- Scheduled non-opioid medication: Paracetamol and anti-inflammatory medication are given on a fixed schedule — not "as needed" — so pain is prevented rather than chased after it starts.
- Adjunct medications: Drugs like gabapentinoids can reduce nerve-related pain sensitivity when appropriate.
- Opioids as a backup, not the backbone: A small opioid dose remains available for breakthrough pain, but is no longer the default first-line treatment.
What this means for you as a patient
- You'll likely receive a nerve block or local infiltration during surgery, before you feel any pain
- You'll be started on scheduled paracetamol and anti-inflammatories from the recovery room, not after you ask
- You'll be encouraged to sit up and walk sooner, because you won't be as drowsy
- Any opioid you do receive will typically be a small, short course, reviewed daily
A note on expectations
Opioid-sparing does not mean pain-free. Some discomfort in the first few days is a normal and expected part of recovery — the goal is pain that is manageable and doesn't stop you from doing your physiotherapy, not the complete absence of any sensation.