At Memorial Hermann Memorial City Hospital, the anesthesia service and I utilize multimodal pain management in all cases of total and partial knee replacement. It is also used in all cases of hip replacement. Multi-modal means we are using a combination of drugs and techniques to minimize the pain experienced. Total knee and hip replacement patients 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. Before surgery patient are also asked to take Celebrex and gabapentin orally. Along with the spinal, patients are given a combination of IV pain reducing drugs including IV Tylenol, and morphine.
Female patients which are at higher risk for post-operative nausea are given a scopolamine patch to place behind their ear. By combining all these drugs that affect various aspects of the pain loop in the nervous system, pain is greatly reduced. Many patients are going home in less than 24 hours after the surgery after total hip or knee replacement.
These are the latest techniques in management of pain in knee and hip replacement patients. By these techniques, we 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 I am finding that the pain after knee replacement is greatly reduced for several weeks.
Partial knee replacement patients are given long acting Novocaine called Marcaine in their knee so they can go home the day of surgery. Partial knee replacement patients do not get a spinal anesthetic. The long acting Marcaine works amazingly well in reducing the pain of partial knee replacement. Because of this pain reduction ability, partial knee replacement is an outpatient surgery. If you have further questions, I will be pleased to answer them.