Calin S. Moucha, MD, chief of adult reconstruction and joint replacement surgery at The Mount Sinai Hospital in New York City was the lead study author.
Here are five points:
1. Dr. Moucha said managing post-surgical pain is key to promoting early postoperative mobility, reducing medication side effects and increasing patient satisfaction.
2. Traditional pain management for TKR includes a computerized pump called patient-controlled analgesia with or without an epidural which can lead to nausea, vomiting, urinary retention, low blood pressure, constipation and itching.
3. Multimodal pain control protocols, include:
- A combination of pain management medications, such as oral medications and nerve blocks taken before and after surgery;
- Regional anesthesia with preoperative nerve blocks performed by an anesthesiologist;
- Intraoperative pain injections performed by the orthopedic surgeon within the knee.
4. Multimodal protocols are found to:
- Lower patient pain severity ratings in the first few days following surgery;
- Minimize unwanted side effects more commonly associated with traditional pain control protocols;
- Reduce the overall amount of narcotic pain medication needed for postoperative pain control;
- Help patients better participate in early postoperative physical therapy and be more satisfied with their postoperative pain control.
5. Dr. Moucha and colleagues also recommend the following:
- Patients should avoid long-term chronic narcotic use for knee arthritis pain control prior to surgery;
- Avoid abruptly stopping oral medications, but gradually taper off as tolerated;
- Pain medication may be necessary beyond the first two weeks for certain activities such as physical therapy sessions, but patients should first speak with their orthopedic surgeon;
- A strong support system
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