Pain Management

We use a combination of medications designed to prevent and down regulate pain as well as to prevent postoperative complications, such as nausea and difficulting urinating. Everyone’s care is individualized for their unique needs. Our protocol starts with medication and fluid you receive while you are in the preoperative holding area prior to your surgery; the type of anesthesia administered during surgery; the combination of medicines injected into the tissues around the surgical reconstruction during your surgery; and medicines from different families of medicines, other than just narcotics, that you are given on a specific schedule once your surgery is complete.

Medications administered the morning prior to or during surgery include:

• Tylenol to lower your sensitivity to pain as well as decrease the amount of pain.
• A  NSAID (nonsteroidal anti-inflammatory) which has proven remarkably effective at decreasing pain via alternate pathways in our bodies.
• Neurontin which also helps to decrease postoperative pain by affecting chemicals and nerves in your body that are involved in pain pathways.
• Medicines that decrease anxiety and make you drowsy. Most patients have no recall of their care after they leave the preoperative holding area.
• A long-acting narcotic to dull pain receptors before pain sets in as well as medication to prevent nausea following surgery.
• An IV steroid just prior to the start of your surgery.
• Tissues under the skin and around the new joint are injected with a “cocktail” made up of three different medicines all from different classes of drugs. This combination has greatly reduced postoperative pain and the need for narcotics. This has resulted in our patients feeling remarkably comfortable immediately after their surgery and helps explain why the vast majority walk just hours after their surgery.
• Partial and total knee patients also receive an adductor nerve block after they are asleep but before their procedure starts. A local anesthetic is injected into the thigh and anesthetizes branches of the femoral nerve.
• Tranexamic acid is also given just prior to making the incision and postoperatively. This medication decreases intra- and postoperative blood loss by stabilizing the blood clot which mitigates the need for postoperative blood transfusion.
• IV antibiotics are also administered before an incision is made which lowers the risk of infection.

Please read my latest blog article Managing Post Operative Pain to learn more.