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Large Joints Feature

Courtesy of Journal of the American Academy of Orthopaedic Surgeons

Study Recommends Changes in Pain Management

Biloine W. Young • Tue, February 16th, 2016

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A study by Calin Moucha, M.D., published in the Journal of the American Academy of Orthopaedic Surgeons, recommends a team-based approach to pain management for patients getting a total knee replacement. Moucha wrote that, “managing post-surgical pain is key to promoting early postoperative mobility, reducing medication side effects, and increasing patient satisfaction."

Traditional pain management includes a patient-controlled analgesia pump with or without an epidural, which can cause nausea, vomiting, urinary retention, low blood pressure, constipation, and itching.

Moucha wrote that newer pain management strategies have proved more effective in pain control than traditional methods and with fewer side effects. These strategies include a combination of pain management medications taken before and after surgery; regional anesthesia with pre-operative nerve blocks performed by an anesthesiologist; and intra-operative pain injections performed by the orthopedic surgeon within the knee.

According to the study, the new method lowers patient pain severity ratings in the first few days post-surgery, minimizes unwanted adverse events more commonly associated with traditional pain control protocols, lowers the overall amount of narcotics needed for post-op pain control, and helps patients better participate in early post-op physical therapy and be more satisfied with post-op pain control.

Researchers added that patients should avoid long-term narcotic use for knee arthritis pain pre-surgery because the lower pain threshold that results may increase post-surgical pain. Patients should not abruptly discontinue oral medications due to the risk of rebound pain and the development of chronic pain.

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