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Pain control in joint replacement


The days leading to a joint replacement are really quite painful that make the surgery inevitable. But the days that follow the surgery might involve even more pain. The pain following the surgery is temporary but would most definitely get in the way of rehabilitation or healing if left untreated.

What are the benefits of managing pain?
Managing the pain effectively is important to achieve the following:

  • Increase in comfort for the patient
  • A decrease in the risk of deep vein thrombosis
  • A decrease in the risk of infections
  • Chances of earlier rehabilitation
  • Increased satisfaction of the patient

The pain needs to be managed before people start to feel it. The pain would certainly become more challenging to alleviate if the neural pathways communicate the pain sensations from the site to the brain which becomes worn after surgery. The medication can be administered shortly before surgery and in regular doses following it.

Multimodal analgesia
The doctors use a combination of the pain relief methods that complement the reactions of each other. The side effects are minimized and the approach is called multimodal analgesia. Though there is no one path to approach multimodal analgesia, the patients might be offered:

  • NSAIDs and steroids decreasing pain and inflammation
  • a peripheral nerve block and pain medications
  • injections of local anaesthetic into the bone

Limited use of opioids
Opioids are narcotic pain medications and patients and medical professionals rely on them. Though they are invaluable in managing pain, the use should be judicious because:

  • the side effects might cause patients unwilling or unable to take part in the rehabilitation exercises
  • opioids might cause fatigue, brain fog, constipation or nausea
  • addiction

Peripheral Nerve Blocks
The sensation at the nerve roots is stopped where the nerves are branching from the spinal cord. The limb undergoing the surgery would be affected. The peripheral nerve block is generally administered before the surgery and can last 36 hours. A general anaesthesia is also used to put the patient to sleep.
The use of peripheral nerve blocks is generally recommended as most clinical studies support their use as they help to control pain and facilitate recovery. Not all the surgeons use such nerve blocks.
Research suggests that the peripheral nerve blocks might contribute to failures in surgery or even interfere with the ability of the patient to participate in physical therapy. The use of peripheral nerve block would depend on the preference of the surgeon and the pain management policy of the hospital and obviously, the condition of the patient.

Patient-controlled Intravenous Analgesia
Many hospitals and doctors prefer to give the patient the control of their own medication. The patient can self-administer the doses of pain-relieving drugs through an IV line by pressing a button. These PCA pumps generally deliver specific doses of opioid medications to the patient such that there cannot be an overdose. This treatment is preferred by many doctors since patients get a sense of control over their pain, while some others might feel that patients might not be able to do so adequately.

The prospective patients should inquire the surgeon of the pain management processes. The questions could be about the pain expectations, the approach of the management and how it would proceed.

Authored By: Dr. S. V. Santpure

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