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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.
What Is Multimodal Pain Management?
At Memorial Hermann Memorial City Hospital, the anesthesia service and Dr. Likover use multimodal pain management in all cases of total knee replacement, partial knee replacement, and hip replacement.
Multimodal means a combination of drugs and techniques are used to minimize the amount of pain after surgery. Before surgery, the patient is given oral medications: gabapentin, Celebrex, and Tylenol.
Hip Surgery Pain Management
Total 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 postoperative pain in the first 24-48 hours. Along with the spinal, patients are given a combination of IV pain-reducing drugs.
Knee Replacement Pain Management
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.
RECK Injections & Nerve Blocks
Knee replacement patients are also given an injection of RECK (an abbreviation for a combination of ropivacaine, epinephrine, clonidine, and ketoprofen) directly into the soft tissues on the side, front, and back of the knee.
Patients are now waking up with almost zero pain in their knees. 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 injection works amazingly well in reducing the pain of partial knee replacement.
Because of the pain reduction ability of this combination of drugs, partial knee replacement is an outpatient surgery.
Scopolamine Patch for Postoperative Nausea
Female patients who are at higher risk for postoperative nausea from any of these surgeries are given a scopolamine patch to place behind their ear.
Pain Management Reduces Postoperative Hospitalization Time
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.
Multimodal Pain Management Minimizes Pain After Surgery
These are the latest techniques for pain management in knee and hip replacement patients. By use of these multimodal 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.
Contact Dr. Likover
If you have further questions, Dr. Likover will be pleased to answer them.
Dr. Larry Likover has been practicing orthopedics on the west side of Houston for 43 years, treating knee, hip, shoulder, and back problems. Dr. Likover is board certified in orthopedic surgery and provides knee replacement in Houston for patients worldwide.