Multimodal Pain Management Program Eases Postoperative Pain for Joint Replacement Patients

The Joint Replacement Team at the Cooper Bone and Joint Institute offers a unique approach to pain management for joint replacement patients. Orthopaedic surgeons Stuart Gordon, MD, FAAOS, and Douglas Tase, MD, FAAOS, joined the joint replacement team in late 2011, bringing with them new pain management protocols.

“Our innovative, multimodal pain management protocols have successfully improved patients’ outcomes and make them more comfortable after surgery,” says Dr. Gordon, Director, Hip and Knee Reconstruction Program. “By installing these protocols, we eliminate the use of perioperative narcotics and prevent pain before it starts.”

This multimodal, multidisciplinary approach affects each stage of surgery and is managed by a team of anesthesiologists, surgeons, nurses and pain management professionals. Prior to surgery, nurses administer Tylenol, Celebrex, and Emend. The anesthesia team, lead by Ronak Desai, DO, Director of Regional Anesthesia, inserts an indwelling continuous femoral nerve catheter. This catheter is attached to a continuous pain medication delivery pump towards the end of surgery and remains connected to the patient for three postoperative days. Patients can ambulate, participate in physical therapy and shower without any interference from the pump. Overall, the reliance on intravenous narcotics to provide analgesia is eliminated through this combination of the indwelling catheter, nerve blocks and the non-narcotic analgesics. After surgery, patients are given proton pump inhibitors, oral narcotics and intravenous Tylenol and Toradol.

By using this multimodal pain management approach, patients rely on fewer narcotics during and after surgery, eliminating postoperative narcotic side effects including lethargy, confusion, nausea, vomiting and pruritus, which can contribute to increased patient satisfaction and outcomes.

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