Multi-modal approach reduces pain and side effects of medication following joint replacement surgery

Reducing acute post-surgical pain and side effects of medications for patients undergoing knee and hip replacement surgery is the focus of a new multi-modal approach at Greenwich Hospital in Greenwich, Connecticut.

Total knee and hip replacement surgeries have become two of the most common surgical procedures performed in the United States; treatment of pain following these surgeries affects a patient's comfort and compliance with physical therapy required for complete healing.

This new multi-modal approach, developed by Greenwich Hospital anesthesiologist Mark Chrostowski, MD, has shown to reduce pain and side effects of medication following joint replacement surgery. It requires collaboration between the departments of anesthesia, orthopedics and pharmacy.

The approach begins by starting the patient on non-opioid medications to control pain and inflammation. Next, patients receive a local anesthetic, either by single injection or a peripheral nerve catheter, to numb the area near the knee or hip where surgery will take place. The catheter tube is inserted through a needle and placed near nerves associated with anticipated surgical pain.

"The procedure is easy to perform and can be completed in less than five minutes under mild sedation," explained Dr. Chrostowski, adding, "We use a state-of-the-art ultrasound machine that allows us to see, in real time, the nerves, surrounding muscles, blood vessels and the medication as it spreads around the nerve."

After surgery, the patient continues to receive non-opioid oral medications as well as the numbing medication through the peripheral nerve catheter that is attached to a disposable pump.

Results have been so dramatic that Greenwich Hospital has been recognized as the 2012 recipient of the Connecticut Hospital Association's John D. Thompson Award for Excellence in the Delivery of Healthcare Through the Use of Data.

"Of the 424 patients for whom we collected data between January 2011 and February 2012, patients who received this new protocol, on average, used 40% less opioids during their entire hospital stay, and the average use of patient-controlled analgesia (morphine pump) decreased by 47%," said Chrostowski. Data was collected from medical records and patient surveys.

Because opioid use was reduced, so were the side effects from these potent medications. For instance, nausea and vomiting decreased by 49% (31% vs. 16%) and 54% (17% vs. 8%) respectively. Pruritis (itchiness) decreased by 97% (26% vs. 1%). Urinary retention decreased by 73% (32% vs. 9%), reducing the need for Foley catheters. And because patients felt more comfortable, they reported increased compliance with post-surgery physical therapy.

"The goal is to return each patient back to their regular activities with reduced pain and a better range of motion," said Chrostowski, who sees potential for using this multi-modal approach for patients undergoing bariatric, major gynecologic, oncologic and other types of general surgery.

Surveys also showed increased patient satisfaction with the overall experience. When compared to 854 other hospitals that participate in a national satisfaction survey, Greenwich Hospital is now ranked in the top 95th percentile.

Source Greenwich Hospital