Pain Management Strategies

Orthopaedic surgery can be a painful experience for many patients.

While many of our "minimally-invasive" procedures such as shoulder and knee arthroscopy can be done with minimal post-operative pain, surgeries such as total joint replacement can cause moderate to severe post-operative pain. Studies have even shown that patients are often reluctant to even consider surgery because of fear of uncontrolled postoperative pain. Over the past decade, a "Multi-modality Pain Management" program has become a standard in Dr. Kaper's management of his surgical patients.

The principles of multimodal therapy is to use interventions that target several different steps of the pain generating pathways. This allows Dr. Kaper to provide more effective control of post-operative pain, with fewer side effects. Better peri-operative pain control provides numerous benefits:

  1. It benefits patients emotionally;
  2. It avoids the unwanted effects of poor pain management including delayed rehabilitation and medical complications;
  3. Helps reduce length of hospital stay;
  4. Reduces unplanned re-admissions after initial hospital discharge;
  5. Keeps the cost of care to the most manageable levels. If pain is not well controlled after surgery, studies have shown long-term compromise of the benefit and function of the total joint replacement.

Historically, pain was managed with high-dose of oral and intravenous narcotic or opioid pain medications. Narcotics, however, have numerous unwanted side effects, including nausea, vomiting, constipation, itching, mental status changes, and respiration depression which can lead to pneumonia or other complications. A recent study (Chung et al, JBJS 2021) showed that there is a dose-dependent increase in the risk of surgical infection and blood clots related to post-operative narcotic use.  Furthermore, recent research has also shown that dependence and even addition to opioids can develop much more quickly than previously thought- within 7-10 days!

For these reasons, the modern Multimodal Pain Management Program is designed to limit the quantity and frequency of the need for narcotic pain medications.

Dr. Kaper's comprehensive pain management strategy uses several interventions:

  1. Preemptive medications (given before surgery), including Acetaminophen (Tylenol); a non-steroidal anti-inflammatory, such as Celebrex or Mobic (Meloxicam); and oral Lyrica.
  2. Peri-articular injections (given during and after surgery) of local anesthetic agents (Exparel, ) that block the pain signals from the operative joint for up to 72 hours.
  3. Regional or spinal anesthesia (given by the anesthesiologist) prior to surgery to block the nerve signals to the brain that would relay pain sensation from the surgical site to the central nervous system.
  4. Post-operative pain medications, carefully titrated and administered prior to the onset of any severe pain.

The overall goal is the accomplish the joint replacement surgery efficiently and effectively to minimize complications and speed the patient's recovery. For more questions about Dr. Kaper's Multimodal Pain Management system, please do not hesitate to contact us.

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