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Joint replacement surgeries, such as hip, knee, and shoulder replacements, are often done to decrease the pain caused by arthritis. Nonetheless, in the days after the surgery, some patients’ distress is just as serious or even worse than their initial arthritic pain. This post-surgical pain is typically short-lived, but it can compromise the healing and rehabilitation if it is left without treatment.
What we will discuss.
- How effective pain management helps patients recover more quickly
- Multiple methods of pain management
- How patients can help guarantee their pain is well managed
- Hospital policies regarding pain management
- The Advantages of Effective Pain Management
Reducing pain is a fundamental component of any joint replacement surgical treatment program. The benefits of pain relief include:
Improved patient comfort. Every joint replacement patient has some level of post-operative pain and efficiently controlling that pain can greatly influence patient comfort.
Earlier and Faster rehabilitation. A patient who has he’s or her pain under control and is more inclined to get out of bed and complete rehabilitation regiment. When performed under the direction and guidance of a surgeon and physical therapist, post-surgical exercise can help decrease the production of scar tissue, improve range of motion, and further the likelihood a successful recovery.
Decreased risk of deep vein thrombosis (DVT). Patients who have experienced a joint replacement are at higher risk of developing a blood clot in a deep vein. When a patient’s pain is under control, he or she can walk about and complete rehabilitation exercises, which increase blood flow and in turn decrease the risk of DVT.
Earlier hospital discharge. The earlier a patient’s pain is managed, the sooner he or she can be released from the hospital.
Lower infection risk. Since the threat of hospital-borne infections, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), an immediate discharge may lessen the possibilities of infection.
Increased patient well-being. Patients who can be self-sufficient and return to their daily routine on schedule or ahead of schedule tend to be more content with their joint replacement surgery.
There is no entirely agreed-upon method to post-surgical pain management. How to best relieve joint replacement patients’ pain is researched continuously and evaluated. One group of experts suggests that most joint replacement patients should have a pain relief program that:
Prevents pain from ever starting (stops it before it starts)
Stop exposure to painkillers called opioids (narcotics) by applying multimodal analgesia
May incorporate usage of peripheral nerve blocks
Each part of this program is explained below. We also described what patient-controlled analgesic pumps are.
Prevents pain from ever starting (stops it before it starts)
Patients can form an elevated sensitivity to pain if it remains untreated. Neuropathways transmit pain sensations from the surgical site to the brain. Once that pathway is well defined, post-surgical pain can grow more difficult to alleviate. Pre-emptive pain management enables patients to avoid this situation.
Pain medicine may even be distributed shortly prior surgery. After surgery, pain medicines may be delivered in regularly scheduled doses during the day.
Examples of multimodal analgesia
There is not one primary approach to multimodal analgesia. For instance, joint replacement patients can receive:
- A peripheral nerve block (defined below) and pain prescriptions referred to as non-steroidal anti-inflammatory drugs (NSAIDs)
- NSAIDs as well as steroids that reduce inflammation and pain
- A needle of local anesthetic into the bone approximate to joint while in surgery to reduce post-surgical pain, in addition to NSAIDs and steroids
- These pain-relieving approaches can change or substitute opioid medications so that the patient needs fewer (or less potent) doses of narcotic drugs.
Reducing the use of narcotic pain prescriptions (opioids)
Medical experts and patients depend on narcotics to promptly mitigate or lessen moderate to severe distress. While they are important and often necessary mechanisms to manage pain, opioid painkillers should be used judiciously because:
Opioids can cause patients to enter into a foggy mental state and feeling exhausted, nauseated, and sick
The side effects can cause a patient feel incapable or unwilling to engage in rehabilitation exercises
Opioids can hook certain individuals.
Opioids are applied in various ways, including via pills, skin patches, needles, or intravenously. They are marketed as prescription pills under brand names such as Vicodin, Percocet, and OxyContin.
In most cases, joint replacement patients benefit from the restricted use of narcotic pain medication.
Peripheral Nerve Blocks
This anesthetic strategy halts the sensation at the nerve roots, where nerves branch off from the spinal cord. Only the particular limb on which the surgeon is working on is affected. For instance, a patient undergoing shoulder replacement may get a peripheral nerve block to the brachial plexus, a collection of nerves that appear in the cervical spine to weaken the shoulder and arm.
A peripheral nerve block, sometimes called a peripheral anesthetic, is administered before surgery and lasts approximately 36 hours.
It can be used in combination with shorter-acting general anesthesia that puts the patient to sleep during surgery.
When this method is used, a patient can wake up from general anesthesia and have little to no pain in the injured limb.
Some experts suggest that joint replacement surgeries include the use of peripheral nerve blocks, and many clinical studies support their use, citing their capacity to regulate pain and facilitate recovery.2,3
Not all surgeons use peripheral nerve blocks. The logic for this include:
They may interfere with patients’ ability to participate in physical therapy shortly after surgery.
Some research implies that peripheral nerve blocks can contribute to hip and knee replacement patients falling during the early healing period,4,5 and hence should be circumvented or used with caution.
Whether a surgeon uses peripheral nerve block will depend upon many factors, including the surgeon’s choice, the hospital’s pain management policy, and the patient’s conditions.
Patient-Controlled Intravenous Analgesia
While it’s not a part of the pain management strategy outlined above, many physicians and hospitals give patients power of their pain medication. For example, during their postoperative hospital stay, joint replacement patients may be given patient-controlled analgesia (PCA) pump.
See Anesthesia for Orthopedic Surgery
With a PCA pump, a patient can push a button to self-administer doses of pain-relieving drugs within an existing IV line. PCA pumps deliver opioid medications, such as morphine or fentanyl. A pump is programmed to release doses precise to the patient, so there is no risk of overdose.
Many physicians like this method of treatment because it gives patients a sense of authority over their pain. Some doctors prefer not to rely on it since patients may not control pain sufficiently or consistently.
Prospective joint replacement patients should ask a surgeon questions about pain management just as they would ask questions about surgical procedures, estimated healing time, and physical therapy. Questions to ask include:
- How much pain should I expect after surgery?
- What is your approach to pain management?
- What combination of painkillers will I be given?
- When does pain management protocol begin—before, during, or after surgery?
- Does this hospital have a standardized pain management protocol?
This last question, regarding a hospital-wide pain management protocol, is not one that many patients think to ask. How hospitals approach to pain management is explained below.
How Hospitals Manage Pain
Some hospitals have a hospital-wide plan for managing joint replacement patients’ pain (health professionals may call this an institutionalized pain management protocol). The orthopedic surgeons, nurses, and other staff all follow the same general guidelines for treating pain. Research suggests that hospital-wide pain-management protocols may have better outcomes.
A standardized approach to pain management does not mean doctors treat each patient the same. Preferably, doctors make choices based on the same pain management model. Improvements to anesthesia and pain medications are made and continuously re-evaluated based on a patient’s physiology, overall health, and pain perceptions.
What if a hospital does not have a centralized approach?
Many hospitals do not have standardized procedures that oversee joint replacement pain management. This does not indicate that a patient’s pain cannot be controlled well at these hospitals. Every surgeon makes the choices that he or she thinks is best for each patient.
Patients who are worried about post-surgical pain management should speak to their physicians.