Preoperative Evaluation, Anesthetic Considerations, 
and Perioperative Oral and Parenteral Medications in Total Knee Arthroplasty.

Effective pain management protocol is critical to early mobilization, early discharge, and increasing patient satisfaction for hip and knee arthroplasty. Surgeons have tried to minimize dependence on opioids and opioid-related adverse events through multimodal protocols that use periarticular injections as well as oral and parenteral medications. The efficacy, cost, and adverse effects of each of these components need to be considered when formulating an evidence-based multimodal pain protocol. Recent advancements have changed understanding of the variability in metabolism of commonly given agents around the time of surgery. It is important to provide a systematic approach to the preoperative evaluation, anesthetic considerations, and the administration of oral and parenteral medications routinely used in total knee arthroplasty.