At The Leone Center for Orthopedic Care, we are very sensitive to our patients concerns about post-operative pain. We’ve learned that patients have less pain and get well faster when they know what to expect after surgery. We believe a well-informed patient has a better recovery.
Our focus is to stay ahead of the pain curve by eliminating pain before it starts. We preempt and diminish pain by using a multi-modal approach with less emphasis on narcotics than traditional treatments. With our approach, we’ve been able to avoid many of the complications which plague patients post-operatively, including nausea, vomiting, constipation and confusion.
Our patients are given IV Tylenol, alternating with an IV NSAID (called Toradol) and a steroid before and after surgery, while emphasizing excellent hydration. During surgery, the tissues around the hip or knee are infiltrated with a pain-management “cocktail,” which includes a combination of a local anesthetic, Toradol, and morphine.
A new medication, Exparel recently became available and also is injected separately into the tissues. Experal is making a wonderful difference because it utilizes a new drug delivery system which results in the slow release of a local anesthetic over two to four days. Our patients are experiencing remarkably little pain.
By using Exparel, we’ve also eliminated local nerve blocks with catheters and pain pumps. This adds safety and helps to avoid delays in therapy due to occasional and temporary muscle weakness. While this “recipe” sounds complex, it actually makes caring for my patients simpler and safer because many potential complications are avoided and they are happier and moving sooner.
The morning after surgery, I typically find my patients smiling, comfortable and ready to begin therapy. We encourage all of our patients to get out of bed, get dressed in their own cloths and walk the first day after surgery. What I’ve found is by diminishing pain and the use of narcotics, patients get well quicker and feel more confident.
Also very encouraging is that both my total and partial knee replacement patients and my total hip replacement patients go home a full day sooner than before we began this multi-modal approach. The best therapy in the world is to be back in your own home and as a surgeon I do everything possible to make that happen as quickly as possible.