This repository contains a scoping review of perioperative analgesic strategy in total knee arthroplasty (TKA), conducted in accordance with JBI scoping review methodology and reported per the PRISMA extension for Scoping Reviews (PRISMA-ScR).
The review maps and synthesizes evidence across five perioperative clinical decision domains:
- Anesthesia modality (spinal versus general anesthesia)
- Regional analgesic technique (ACB, IPACK, periarticular infiltration)
- Intraoperative adjuvant pharmacology (opioid-minimizing strategies)
- Patient risk stratification (opioid tolerance, catastrophizing, central sensitization)
- Outcome measurement (KOOS, WOMAC, PROMIS, MCID calibration)
Evidence gap implications for robot-assisted TKA (rTKA) are mapped throughout. All rTKA-specific conclusions are designated as evidence-gap inferences rather than established findings.
60 sources included. Search conducted through March 21, 2026.
| File | Description |
|---|---|
| George-TKA-Scoping-Review-v2.pdf | Submission-ready scoping review — PRISMA-ScR compliant, 32 pages, 60 sources, 5 evidence domains, PRISMA flow diagram and checklist included as supplementary files within the document |
| George-TKA-Scoping-Review-v2.md | Markdown source for the scoping review |
Preprint: Submitted to medRxiv. DOI will be linked here upon issuance.
The scoping review was developed from five domain-specific evidence reviews. These are provided as supporting source documents.
| File | Domain | Central Finding |
|---|---|---|
| 01 — Regional Anesthesia: ACB, IPACK, and Functional Preservation | Regional analgesia | ACB non-inferior to FNB on pain; GRADE A quadriceps-preservation advantage; IPACK adds posterior capsular coverage (GRADE B) |
| 02 — Opioid-Free Intraoperative Anesthesia | Adjuvant pharmacology | NSAIDs/COX-2 GRADE A; ketamine GRADE B (strongest in opioid-tolerant patients); ceiling effect problem invalidates bundle-level OFA evidence in neuraxial-plus-block pathways |
| 03 — Patient-Reported Outcomes and Functional Recovery Measurement | Outcome measurement | KOOS/WOMAC MCID thresholds poorly calibrated for high-risk phenotypes; PGIC underutilized as patient-anchored validity check |
| 04 — Spinal Versus General Anesthesia | Anesthesia modality | Neuraxial preference GRADE B for PONV and opioid exposure; blood loss advantage era-dependent (pre-TXA); thromboembolic advantage GRADE C |
| 05 — Chronic Pain, Opioid Exposure, and Risk Stratification | Risk stratification | Preoperative opioid use GRADE A predictor; catastrophizing GRADE B; composite high-risk phenotype affects 20–40% of TKA candidates |
Reading sequence (clinical decision logic): 04 → 01 → 02 → 05 → 03
This follows anesthesia platform → regional technique → adjuvant pharmacology → patient risk modification → outcome measurement adequacy.
tka-perioperative-review/
├── README.md
├── George-TKA-Scoping-Review-v2.pdf ← Primary output (submit to medRxiv)
├── George-TKA-Scoping-Review-v2.md ← Markdown source
├── 01_Regional_Anesthesia_ACB_IPACK.md
├── 02_Opioid_Free_Anesthesia_TKA.md
├── 03_Patient_Reported_Outcomes_TKA.md
├── 04_Spinal_vs_General_Anesthesia_TKA.md
├── 05_Chronic_Pain_Opioid_Risk_Stratification_TKA.md
├── CITATION.cff
└── LICENSE
- All primary evidence is derived from conventional TKA or mixed arthroplasty populations. No primary evidence is specific to robot-assisted TKA.
- PubMed/MEDLINE was the primary bibliographic database; Embase, Cochrane, and Scopus were not searched.
- Screening was conducted by a single reviewer. No duplicate independent screening was performed.
- Formal risk-of-bias scoring was not performed, consistent with JBI scoping review methodology.
- These limitations are reported transparently in Section 9 of the scoping review.
This is not:
- Medical advice or clinical guidance of any kind
- A clinical protocol, institutional guideline, policy, or order set
- Approved or validated for clinical implementation
- A substitute for attending anesthesiologist or surgeon judgment
- A preclinical or clinical research package
- A regulatory submission or product development document
- An official University of Washington or UW Medicine document
- A document reviewed, approved, or authorized for institutional implementation
- An endorsement or representation of the views of any institution, faculty member, or clinical educator
The literature reviewed in this scoping review spans heterogeneous clinical populations, institutional practices, anesthetic techniques, and evidence quality levels. Although this review was conducted in accordance with JBI scoping review methodology and reported per PRISMA-ScR, it was performed by a single reviewer without duplicate screening and with PubMed/MEDLINE as the sole bibliographic database. Findings reflect the mapped evidence base and should not be read as validated clinical guidance, performance targets, or prescriptive standards of any kind.
This repository is appropriate for:
- Scholarly review of perioperative analgesic evidence in total knee arthroplasty
- Academic analysis of evidence gaps in robot-assisted TKA analgesic research
- Educational discussion of risk stratification and outcome measurement methodology
- Independent academic and medical school application portfolio presentation
It is not intended for patient care, clinical decision-making, institutional implementation, or documentation use.
This is an independent scholarly work. It is not affiliated with, endorsed by, reviewed by, or issued on behalf of the University of Washington, UW Medicine, or any healthcare, academic, or professional organization. All interpretations, conclusions, and any errors are solely the responsibility of the author.
Collin Blaine George, BS
ORCID: 0009-0007-8162-6839
GitHub: github.com/collingeorge
University of Washington, Department of Laboratory Medicine and Pathology
Seattle, Washington
March 2026
This is an independent scholarly work. It is not affiliated with, endorsed by, reviewed by, or issued on behalf of the University of Washington, UW Medicine, or any healthcare, academic, or professional organization. All interpretations, conclusions, and any errors are solely the responsibility of the author.
See CITATION.cff for machine-readable citation.
Collin Blaine George. Perioperative Analgesic Strategy in Total Knee Arthroplasty:
A Scoping Review Across Anesthesia Modality, Regional Techniques, Adjuvant
Pharmacology, Risk Stratification, and Outcome Measurement. Version 2.0.
March 2026. https://github.com/collingeorge/tka-perioperative-review
This work is licensed under a Creative Commons Attribution 4.0 International License. See LICENSE for full terms.