Patient satisfaction and outcomes are increasingly influencing reimbursement, and multiple studies have shown a direct correlation between increased pain and decreased patient satisfaction. The current focus on opioid overuse has made perioperative pain management a challenge. This issue of Orthopedic Clinics of North America highlights some of those difficulties and provides discussions of alternate pain management strategies in orthopedic patients.

With an aging population, total joint arthroplasties (TJA) are common procedures to combat end-stage joint degeneration for which conservative measures have failed. Rutherford, Jennings, and Dennis review the evidence for modern practices regarding patient selection and education, anesthetic techniques, perioperative pain management, intraoperative factors, blood management, and postoperative rehabilitation. The importance of pain management in the rapid recovery of TJA patients is highlighted by Russo, Parks, and Hamilton, with a discussion of rapid recovery protocols. Gaffney, Pelt, Gililland, and Peters present a multimodal pain management approach to avoid adverse effects of opioids while improving patient satisfaction. Although innovative surgical and pain management techniques have improved the outcomes of total knee arthroplasty, 10% to 15% of patients are dissatisfied with their results. Gibon, Marla Goodman, and Stuart Goodman present an in-depth discussion of how the multifactorial causes of patient dissatisfaction, including pain, can be addressed.

Pain control is especially important in orthopedic trauma patients, in whom opioids have traditionally been the most common choice. As pointed out by Richards, Graf, and Mashru, however, side effects of opioids and nonsteroidal anti-inflammatory medications used for pain control may impede fracture healing. Jones, Southerland, and Catalani describe methods for optimizing acute pain management in orthopedic trauma patients.

Two articles by pediatric orthopedic surgeons, one by Frizzell, Cavanaugh, and Herman and the other by Sheffer, Kelly, Sawyer, and Rhodes, discuss the challenging issue of pain control in pediatric patients, including multimodal approaches, accelerated postoperative pathways, and regimens customized according to patient and surgery characteristics that are unique to these young patients.

Because many hand and foot and ankle surgeries are done as outpatient procedures, local and regional anesthesia techniques are commonly used. Authors Coleman; Kohring and Orgain; and Fraser and Doty outline anesthesia options and methods to minimize their side effects while providing excellent pain relief. Techniques such as wide-awake surgery, wound infiltration, combinations of pharmacologic and other modalities that target multiple pain mechanisms and receptor pathways can reduce dependence on opioids.

We hope the information provided in this issue will be helpful to you in developing perioperative pain management protocols for your patients.