Advances in Pain Management Mean Less Pain After Joint Replacement Surgery
(New York, N.Y. February 20, 2019.) When considering joint replacement, many patients worry about the pain they could experience after surgery. Just ask Susan Lucanto, who just turned 60. She says she experienced so much pain after her first knee replacement nine years ago, that she felt a lot of anxiety when the implant started to loosen and she required a second surgery. She was afraid she would experience the same pain all over again.
For the second procedure, known as a revision knee replacement, Ms. Lucanto went to a different orthopedic surgeon: a doctor specializing in revision surgery. This time she consulted with Dr. Geoffrey Westrich, research director of the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery (HSS) in New York City.
Dr. Westrich assures his patients that physicians and researchers at HSS have studied pain management at length and have developed a protocol that aims to ensure pain is well managed after surgery. Of course, every patient is different, but he and his pain specialist colleagues have found that “multimodal analgesia” – the administration of two or more drugs targeting multiple pain pathways – is very effective in managing pain. Anesthetic pain medication is now administered inside the joint itself during surgery, and the patient then receives the multimodal pain control protocol after the procedure.
Ms. Lucanto says it worked like a charm. Although revision knee replacement is more demanding on the patient than a primary knee replacement, she says pain was not an issue after the second surgery.
On the Hospital for Special Surgery web portal known as “Back in the Game,” patients can post their experiences. Ms. Lucanto wrote: “On October 4, 2018, I underwent a left knee revision at HSS located in New York City. My surgeon and hero was Dr. Westrich. It was one of the best experiences in my life, seriously. I went in on a Thursday and I left the next day, walking on my own with the help of a cane. After two weeks… I went back to work!” https://backinthegame.hss.edu/story/susan-lucanto/
Ms. Lucanto also described how her second surgery differed from her original knee replacement: “When I was waiting on the day of the revision surgery, I was scared of what I was facing. My original left knee replacement in April 2009 was extremely painful. However, I am totally blown away by how different my knee replacement surgery in April 2009 was from my left knee revision this past October. There was hardly any pain with the revision. With the (first knee) replacement, I was out-of-work for 3 months.”
Ms. Lucanto was so pleased with her recovery that she told a patient she met in physical therapy about her experience. “The woman has very bad arthritis in both knees, but says she is ‘terrified’ to have knee replacement because she’s afraid of the pain. I don’t think anyone should have to suffer with arthritis, especially when these pain blockers can make the surgery a lot easier.”
“Clearly, we have seen many advances – and changes – over the years in the way we manage pain after joint replacement,” Dr. Westrich explained. “We now know that although opioid medication is highly effective and often part of the overall pain management plan after surgery, it should be used in the lowest dose needed to provide pain relief and for the shortest amount of time necessary.”
Dr. Westrich adds: “At HSS, we have found that our multimodal pain control system, in which pain-blocking medication is administered intraoperatively, as well as to the patient after surgery, has lessened the amount of opioids many patients need after joint replacement.”
Ms. Lucanto says that by the time she went home the day after revision knee replacement, she no longer needed opioid medication and only took over-the-counter extra-strength Tylenol for pain management.
Dr. Westrich and his colleagues in the Department of Anesthesiology at HSS continuously strive to improve patient care, and studies are ongoing in the realm of pain management. “Our ultimate goal is to have a greater understanding of which multimodal pain protocol is best for a given patient, aiming to minimize the amount of narcotics to limit the side effects associated with such medications,” he added. “We hope to optimize this in future research.”