Dr. William Bose is an orthopaedic surgeon practicing in Mobile, AL. Dr. Bose specializes in the diagnosis, treatment and rehabilitation of injuries, diseases and disorders of the bodys musculoskeletal system. As an orthopaedic surgeon, Dr. Bose tends to bones, ligaments, muscles, joints, nerves and tendons. Orthopaedic... more
Achievement of a good outcome after an orthopaedic procedure such as knee, hip or shoulder replacement, fracture repair, rotator cuff repair, or hip arthroscopy requires that the extremity moves immediately after surgery. We call this “early mobilization”. But, when the patient has pain, they naturally will not move the extremity for fear of increased pain. However, if the patient does not move the extremity, it will become stiff and a good outcome is not possible.
So the challenge is, how can I relieve a patient's pain after surgery so they can begin early active motion of the involved extremity and achieve an excellent surgical outcome?
In the past, the only tool available was morphine, or narcotic medications. These do relieve pain, but have the negative side effects of drowsiness (can’t do physical therapy), altered mental status (falls), nausea and vomiting, and decreased breathing (very bad).
Regional blocks can be used. However, I find that they are time consuming, they often do not work because the injection is off target, and they can cause muscle paralysis post-op, that can cause falls. Therefore the use of this technique is limited in my practice.
I have found that periarticular injections of long acting local anesthetic agents combined with corticosteroids have been extremely effective in relieving pain after surgery. During the procedure, I will carefully inject into the surrounding tissues and near the nerves that are close by. This will reduce a patient’s pain after surgery by 50% or more. I have found this technique to be extremely helpful for early mobility after surgery.
The use of oral agents before surgery have been helpful as well. Celebrex, an anti-inflammatory drug, and a long acting opiod drug are given to my patients one hour prior to surgery. They help to reduce pain and swelling after surgery, aiding early mobilization.
Finally, I use a product called “platelet rich plasma” or PRP. It turns out that the tiny cells in our blood called platelets are filled with healing proteins. These proteins stimulate clot formation, wound healing, and blood vessel formation. I harvest a tube of blood from the patient before surgery, spin it to get the platelets out, then spray this preparation into the wound prior to sutures. As a result, I have noticed after surgery such as knee replacements, that patients have less bleeding and pain, allowing early mobilization. Additionally, the wound seems to heal faster. I believe that this substance has improved outcomes in my patients after surgery.
Thankfully, the combination of the above techniques as significantly reduced postoperative pain in my patients, allowing a faster, less painful recovery process. Additionally, it has reduced opiod consumption in patients, which has reduced the complication associated with narcotics.