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Featured Tip How To Control Pain After Knee Replacement ?

  • Dr Sanjay Bansal
  • 02 August, 2018

Knee replacement can be highly painful. Previously, opioids or narcotics were conduct for pain relief. But imprudent addition of opioids is not absolutely effective for controlling pain. Multimodal pain management has become an major part of the surgical care of patients undergoing entire joint replacement . The principle of multimodal therapy is use to intercession that target different steps of the pain pathway, granting more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to give a concise overview of the principles and outcomes of multimodal pain management regimens as a experiential guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

1. Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

2. Patient Controlled Analgesia (PCA): This method is also known as ‘Pain Pump’. An intravenous pump is apply to control pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be forced, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

3. Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Otherwise, acetaminophen, such as Tylenol or its equivalent composition, can also be applied.

4. Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

5. Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is matter to side effects such as dizziness, urinary retention and itchiness.

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