A study published in the Journal of the American Academy of Orthopaedic Surgeons shows a team-based care approach, along with newer pain management strategies, can lead to quicker and shorter recovery times for patients after total knee replacement surgery.
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