So you’re ready to have your knee replaced. You’re tired of the pain and stiffness that affects your daily activity caused by your arthritic knee. Total knee replacement surgery is your best option, but you’ve heard horror stories about the pain from your friends—and you’re scared.
Well, there’s good news. Today’s pain control after knee replacement surgery limits the pain level and allows most patients to recover quickly and with little discomfort. How is this done?
- Multimodal anesthesia
- Peripheral nerve blocks
- Rapid mobilization
- Cryotherapy (ice)
Multimodal anesthesia has evolved over the last several years. Physicians have found that drugs other than narcotics can significantly reduce pain. Of course, you will still require some narcotic medications such as Dilaudid or Percocet, but in smaller amounts than a few years ago.
Today, patients are given intravenous Tylenol and oral doses of Celebrex, which control pain signals through a “pain gate” (nerves carry the signals to the brain through a “gate” where pain levels can be increased or decreased) and can help reduce pain without reliance on narcotics. By reducing and sometimes eliminating narcotics, you feel better, experience less constipation, need less sedation, and are less likely to experience depression—all of which can accentuate pain.
The second fact of multimodal anesthesia is the periarticular injection. At the time of surgery, a long-acting local anesthetic is injected into the tissue surrounding the knee joint. This mixture deadens the pain for up to 24 hours and reduces the discomfort significantly. Some of these drugs can deliver the anesthetic for up to 72 hours, thereby further reducing the need for narcotics.
Peripheral nerve blocks
Peripheral nerve blocks have significantly reduced pain after knee replacement. Prior to the commencement of the surgical procedure, an anesthesiologist will inject a long-acting anesthetic agent around the nerves that provide sensation to the knee. Just as when you go to the dentist and have an anesthetic injection to block the facial nerve, the big nerve to the knee—femoral and/or saphenous—can be blocked as well. The knee is then “numb” for up to 24–48 hours. You can still walk and participate in physical therapy, but your knee is pain-free.
Another way to reduce pain is through rapid mobilization. This may seem counterintuitive to most patients, but multiple studies have shown that the sooner you get out of bed and start bending your new knee, the less pain there will be later. Lying in bed only increases the chance for a serious side effect or complication. In fact, in some cases, knee replacement surgery can be safely done on an outpatient basis.
Last, ice or cryotherapy has been proven to help reduce swelling and pain. When you schedule surgery at Washington Orthopaedics & Sports Medicine, you will be encouraged to purchase a machine that continuously delivers cooling to your knee through a custom sleeve that wraps around the knee. The sleeve applies compression, which reduces swelling and delivers a constant flow of ice water therapy to the knee. The cost is minimal and the benefits are significant.
So go ahead and regain your lifestyle with knee replacement surgery. This procedure no longer results in horror stories of pain that patients experienced years ago. Now you can get back on your feet and return to your active lifestyle pain-free.
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Dr. Anthony S. Unger is a nationally recognized expert in joint replacement and minimally invasive surgery. He has trained surgeons around the world, published numerous peer-reviewed reports and articles on hip procedures, and performed over 4,000 hip replacements over 28 years. In addition to serving on the WOSM staff, Dr. Unger is medical director of the Institute of Bone and Joint Health at Sibley Memorial Hospital in Washington, D.C., and a clinical professor of orthopaedic surgery at George Washington University Hospital.