Treatment reduces pain, speeds recovery for knee or hip replacement

Patients undergoing knee or hip replacements recover more quickly when treated with targeted pain-blocking medications that may eliminate the need for general anaesthesia during surgery and intravenous narcotics drugs after surgery.

The February issue of Mayo Clinic Health Letter explains the newer pain management options and their benefits.

A decade ago, patients undergoing hip or knee replacements were almost exclusively given general anaesthesia during surgery and intravenous narcotic pain medications afterward. This approach works for most people and still is commonly practiced. But both general anaesthesia and intravenous narcotic drugs can cause nausea, vomiting, grogginess, decreased bowel function and other side effects.

In the early 2000s, Mayo Clinic anaesthesiologists began developing new anaesthesia protocols for joint replacement surgery that used known anaesthetic and pain relief techniques in new combinations. Their goal was to eliminate the need for general anaesthesia and intravenous narcotics and the resulting side effects.The new procedures may vary but typically involve:

A choice: Even with the new protocols, patients may choose regional anaesthesia, where the lower half of the body is numbed, or general anaesthesia.
Oral pain medications early on: A combination of oral narcotic pain medications are given prior to surgery. Oral narcotics have fewer side effects than narcotics given intravenously. This technique is helpful for recovery whether general or regional anaesthesia is used.
Sedation: Sedative drugs given before surgery help patients using regional anaesthesia nap during the procedure, but not lose consciousness.
Nerve blocks: Through a catheter, a continuous infusion of numbing medicine is pumped near the surgery site for 48 hours. Nerve blocks are performed in conjunction with general or regional anaesthesia.
Oral pain medications after surgery: For more than 95 percent of patients, pain that occurs after the nerve blocks are removed can be managed with oral pain medications such as acetaminophen (Tylenol, others), tramadol (Ultram, others) or oxycodone. Intravenous narcotic medications are used as a last resort.

Patients who receive regional anaesthesia report significantly less pain after surgery than those receiving general anaesthesia and intravenous narcotics. These patients are out of bed sooner, begin physical therapy sooner and leave the hospital one to two days before patients who were given general anaesthesia and intravenous narcotics. With the newer protocols, patients may still experience typical side effects including nausea and vomiting, but to a lesser degree than with the older anaesthesia methods.Another benefit is that regional anaesthesia protocols make surgery an option for older adults with more complicated conditions. A decade ago, older adults often were not considered candidates for surgery because they would have fared poorly with older anaesthesia techniques.

Doctors report few downsides to these newer pain management approaches. Nerve injury is a rare potential complication. For most people, the regional anaesthesia protocols are a change for the better, resulting in less pain, fewer complications and a quicker recovery.

(Source: Mayo Clinic: Mayo Clinic Health Letter: February 2010)