I read the above in A and A back in October ( so I can't get the full article) and thought it was interesting.
A group of orthopods ( so yes there will be some bias) compared spinal morphine to high volume LA infiltration for TKA's and found infiltration to be superior for pain relief. It wasn't a perfect study. They only gave 100 mcg of morphine with no multimodal therapy. The infiltration group received ketorolac in the mix in addition to a joint catheter that was dosed with the same cocktail the following AM. So it remains to be determined whether this was a local or systemic effect. I was impressed with the pain relief achieved in the local group and thought that they should do a follow up study where patients get both interventions. It would also be nice to see a study comparing a local vs systemic group. At any rate, I thought the spinal Marcaine plus duramorph plus multimodal therapy with the above would make for a fairly simple and effective anesthetic for a TKA protocol. It also allows for early mobilization. Any thoughts on joint pathways?