The main fear of patients requiring total or partial knee replacement is the amount of expected pain after surgery. Dr. Likover’s goal is for a knee or hip replacement patient to have as little pain as possible after surgery so that you can get back to doing the things you love as soon as possible.
At Memorial Hermann Memorial City Hospital, the anesthesia service and Dr. Likover utilize multi-modal pain management in all cases of total knee replacement, partial knee replacement, and hip replacement. Multi-modal means they are using a combination of drugs and techniques to minimize the amount of pain after surgery. Before surgery the patient is given oral medications: gabapentin, Celebrex and Tylenol.
Total hip replacement patients for the surgery are given a spinal anesthetic with morphine and Ropivacaine (a type of Novocaine) placed in the spinal fluid. The patient is not given a general anesthetic, unless the spine is not accessible to a spinal or there is a medical reason why the patient cannot have a spinal. Spinal morphine greatly reduces the severe post-operative pain in the first 24-48 hours. Along with the spinal, patients are given a combination of IV pain reducing drugs.
Total and partial knee replacement patients are given a nerve block to the adductor nerve and geniculate nerves that go to the knee. These two pain blocks prevent pain impulses from getting to the brain. Total and partial knee replacement patients are also given directly into the soft tissues on the side, front and back of the knee an injection of RECK. RECK is an abbreviation for a combination or ropivicaine, epinephrine, clonidine and ketoprofen. Patients are now waking up with almost zero pain in their knee. Before these advances patients woke up from surgery screaming and stayed in the hospital three to five days due to pain.
Partial knee replacement patients do not get a spinal anesthetic, but they do get a nerve block. The long acting RECK works amazingly well in reducing the pain of partial knee replacement. Because of this pain reduction ability of this combination of drugs, partial knee replacement is an outpatient surgery.
Female patients which are at higher risk for post-operative nausea from any of these surgeries are given a scopolamine patch to place behind their ear.
The bottom-line concept is that the knee is made almost totally numb. By combining all these drugs that affect various aspects of the pain loop in the nervous system, pain after surgery is greatly reduced. The brain is being fooled into not knowing a part of the body had surgery. Many patients are going home less than 24 hours after total hip or total knee replacement.
Medicare has now authorized total knee replacement as an outpatient surgery.
These are the latest techniques in management of pain in knee and hip replacement patients. By use of these multi-modal pain management techniques, Dr. Likover and the anesthesia doctors are reducing the pain of knee and hip replacement surgeries to a minimum.
The patients that have undergone this type of pain reduction are most pleased by the fact that their joint replacement was not a horrible experience, and they have found that the overall pain after surgery is greatly reduced over the first six weeks after surgery.
If you have further questions, Dr. Likover will be pleased to answer them.