Orthopaedic post-operative pain management

Published on: 3 September, 2014

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Post-operative pain management remains a problematic factor within the orthopaedic industry. Poorly managed postoperative pain results in resource and finance stresses to our health system and also directly to the patient.
Any operation involving a body cavity, large joint surfaces or deep tissues should be regarded as painful. Pain causes an increase in the sympathetic response of the body including heart rate, cardiac work and oxygen consumption. Prolonged pain can reduce physical activity and an increased risk of nausea, vomiting, urinary retention, deep vein thrombosis and pulmonary embolism.
The most common form of pain management is the ingestion of opioids. Administering post-operative opioids as a pain management device can, at times, be more detrimental than helpful in the recovery process. Opioids can be addictive and some patients use them to self-medicate their anxiety, depression or otherwise mental dependencies. Opioids occasionally cause myoclonus, seizures, confusion, sexual dysfunction, sleep disturbances, urinary retention and skin irritation. Prolonged use is known to affect sexual function and libido in both men and women. The mental ‘mountains’ are often far more difficult to climb then the physical ones, and patients who become dependent on opioids to manage their recovery may find that reliance actually has the opposite effect.
The ultimate goal after any orthopaedic surgery is to minimise the pain and discomfort suffered by the patient. Regional anesthetic techniques can be carried out with minimal risk to the patient and include local infiltration of incisions with long-acting local anesthetics, blockade of peripheral nerves or plexuses and continuous block techniques peripherally or centrally. Regional anesthetic techniques can decrease post-operative pain to a manageable level allowing the patient to recover without succumbing to the effects of opioids in the body. Nerve blocks are becoming more widely used for orthopaedic related surgeries since it often allows the patient to return home hours after the surgery has been successful.
Blockade of plexuses or peripheral nerves will provide selective analgesia in those parts of the body supplied by the plexus or nerves. These techniques can either be used to provide anesthesia for the surgery or specifically for postoperative pain relief. The practice of regional anesthesia has expanded greatly over the past two decades. As nerve block techniques, availability of training programs, equipment and technology have progressed, more patients are benefiting from superior non-narcotic postoperative pain control reducing the need for opioids and their related complications. The impact is particularly evident in orthopedic surgery where patients may achieve earlier mobilization and return to daily activities, in addition to shorter hospital stays, with fewer complications.
Patient Benefits of Continuous Peripheral Nerve Blocks (CPNB) in Orthopedic Surgery include:
• Quicker rehabilitation and time to ambulation
• Earlier time to discharge
• Higher Patient Satisfaction
Didier Sciard, M.D. quoted “Collaboration between surgeons and anesthesiologists regarding postoperative pain management contributes in improving patient outcomes and satisfaction. A successful nerve block program as part of a multimodal approach of postoperative pain management is the key. Pain after orthopedic procedures can be easily controlled by continuous peripheral nerve blocks even in ambulatory settings.”

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