Pain Management Techniques

Advancements in pain management have made post-operative joint replacement considerably less uncomfortable than as recently as three years ago. It's a significant milestone in joint replacement post-operative care because the presence or absence of pain not only changes the way patients feel; it can impact the long-term success of the prosthetic joint.

According to Roger Raichelson, M.D., Director of the Anesthesia Department at Nyack Hospital, pain can increase length of stay in the hospital, hinder a patient's motivation and the ability to tolerate rehabilitation, and affect the degree of mobility the patient is able to ultimately achieve.

However, these concerns are rapidly diminishing with the advent of cutting edge multi-modality analgesia techniques.  After receiving sedation, the Anesthesiologist places a block which minimizes pain in the early postoperative period.  Narcotics and non-steriodal analgesics are used in combination with the regional blocks to keep the total joint patients as comfortable as possible.  “So for the first two days post-op, when pain is at its maximum, we can minimize what a patient actually experiences both at rest, and while they're in motion,” explains Dr. Raichelson. “Patients used to see the rehabilitation doctors coming and wince at the thought of having to do physical therapy. Now that's much less the issue. Newer pain modalities also include the use of a continuous femoral nerve catheter that minimizes discomfort and allows for early mobility after knee replacement.”

When the Joint Replacement Center first opened, a slow release narcotic was placed in the epidural space for total knee and total hip replacement patients.  Although effective, patients experienced nausea, vomiting and itching with the narcotic medication.  Since the combined analgesic techniques have been utilized, patients have been able to get out of bed and start physical therapy sooner, regain their mobility and leave the hospital earlier (usually after three days). Furthermore, the doctor points out, “When pain pathways are blocked before they're formed, the total amount of pain people experience is reduced. Even after discharge, they actually feel less pain.” He says orthopedic surgeons are “ecstatic” about 48-hour timed-release pain management because “the earlier patients get moving, the greater range of motion they will achieve down the line.”

Presently, there is no technique that can keep you totally pain free following joint replacement surgery.  Pain levels are quantified by using a point scale where zero is “no pain at all” and ten is “the worst pain imaginable.”  By definition, five indicates a certain amount of pain that you can sleep through.  The goal of the Anesthesia Department is to keep your pain scores below that “five” threshold.  Every patient is different, and techniques that work for one patient may not work for another.  Our anesthesiologists provide individualized care and are available throughout your hospitalization to make sure that you are kept as comfortable as possible.  We take great pride in the Joint Replacement Center and work to provide an excellent experience during your hospitalization.