Attack Joint Replacement Surgery Pain Before It Starts

by Savyasachi C. Thakkar, MD, Orthopaedic Surgeon, MedStar Orthopaedic Institute, James Edward Tozzi, MD, Chair of the MedStar Orthopaedic Institute, MedStar Washington Hospital Center
November 13, 2018

Hip and knee replacements have played an important part in the treatment of arthritis and other painful joint conditions for decades. However, recovery from surgery and subsequent inflammation can be painful. Many patients had to rely on opioid medications, which can lead to stomach problems and sometimes addiction.

Fortunately, today’s patients have another effective, safe option: multimodal pain control techniques. Multimodal pain control lets us tackle your pain before, during and after joint replacement surgery to significantly reduce pain, shorten recovery time and reduce the need for strong pain medication after surgery.

LISTEN: Dr. Savyasachi C. Thakkar Discusses Multimodal Pain Control in the Medical Intel Podcast.

Our Three-Pronged Recovery System

The process of hip replacement or a knee replacement recovery is three-pronged:

  1. Having a post-anesthetic care coordinator, which is a program developed by the Chair at MedStar Washington Hospital Center for patients undergoing primary joint replacement and revision.
  2. An advanced recovery after surgery program, developed by the Chair of the Department of Orthopaedics, and Dr. Susan Dumsha Stasiewicz, anesthesiologist, at MedStar Washington Hospital Center.
  3. Multi-modal pain management, a primary and critical point in recovery for patients undergoing primary joint replacement and revision. This includes preoperative medications, an intraoperative cocktail or injection, and postoperative medications that have been fine-tuned by the arrival of fellowship-trained joint surgeon, Dr. Savyasachi Thakkar.

This strategy often allows us to perform the joint replacement surgery using local anesthesia, rather than general anesthesia. In doing so, we can avoid complications in your heart or lungs and decrease the risk of nausea and low blood pressure after surgery.

Most patients benefit from this approach, but others may need more aggressive pain management. Our joint surgeons, anesthesiologists and pain management experts collaborate to identify those at greater risk for severe pain after surgery, as well as what’s likely to trigger their pain. Together, we set realistic goals for pain management.

Better Pain Control and Faster Recovery

You’ll likely want your pain to be completely gone right after your surgery. Of course, we understand that—but it’s not feasible. You’ll likely experience some pain after surgery, and a multimodal approach can make it more tolerable with lower amounts of opioid medication. Studies have shown that people who take opioid pain medications for longer periods after joint replacement surgery do not see a reduction in their pain. In addition, we’re currently seeing the effects of the national opioid epidemic, in which tens of thousands of people die every year due to overdoses of these powerful drugs.

Traditional pain management methods have focused only on the time after joint replacement surgery and only by prescribing powerful pain medications. By modifying our pain-control protocols, patients who have had joint replacement surgery see a number of benefits, such as:

  • Lower doses of opioid pain medications
  • Shorter duration of taking them
  • Reduced risk of dependence
Modern #paincontrol techniques after #jointreplacement surgery mean patients need lower doses of #opioid pain medications for a shorter time. via @MedStarWHC

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In addition, our advanced surgical techniques have made it possible for many patients to have joint replacement surgery on an outpatient basis, meaning they can go home the same day as their procedures. People often report lower pain scores when they are able to be at home, in their own beds, with their loved ones, rather than being in an unfamiliar hospital environment during their recovery periods.

A Potential Breakthrough in Pain Control for Joint Replacement

Multimodal pain management is a vast improvement over the traditional approach, but we’re not satisfied with the status quo. Our team has helped to pioneer further pain control advances for joint replacement patients, such as nerve ablation.

In nerve ablation, pain management specialists use radiofrequency ablation, which involves high-energy radio waves, to reduce the sensitivity of the nerves around the site where we will make our surgical incisions. The ablation process “quiets” the nerves near the surgical site, which means those nerves report less pain to the brain and also decrease the amount of inflammation in those areas after surgery. The patient can use their new joint quicker and more effectively without the normal pain and inflammation. We repeat the process about six weeks after surgery to continue to relieve the patient’s pain. After that, the nerves will “wake up” again, and the patient’s skin and scar will have healed.

What we’ve seen so far indicates that patients who have nerve ablation before their surgeries have significantly better outcomes than those who don’t. We’re still studying the data from our research, but it would be exciting if this led to patients one day not needing to take any pain medication at all after joint replacement surgery.

It’s critical for us to successfully manage your pain when you undergo total joint replacement. Keeping pain under control means you’re at much lower risk from long-term use of pain medications, and you can enjoy your new joint faster as part of an active, healthy lifestyle.

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Category: Medical Intel     Tags: hip replacementjoint replacementknee replacementpain-managementtotal joint replacement