New Protocol for Pain Management During and After Knee and Hip Replacement Surgery

Stephanie Lachapelle for Knee1

            Several options are now available for coping with pain associated with knee and hip replacement.

Patients undergoing hip or knee replacement surgery were typically put under general anesthesia during surgery and were treated with intravenous narcotic pain medications post-surgery a decade ago. Although this method of pain control is still commonly practiced, these drugs often cause nausea, vomiting, grogginess, and other unwanted side effects. Now, targeted pain-blocking therapies exist that allow patients to recover from surgery more quickly by reducing the necessity for both general anesthesia and narcotic drugs.

With the goal to eliminate the need for general anesthesia and use of narcotic drug associated with replacement surgery, Mayo Clinic anesthesiologists began developing new protocols for surgery in the early 2000’s. Now, patients may opt for general anesthesia, but may also choose only regional anesthesia, where only the lower half of the body is numbed during surgery. With this option, patients are treated with oral narcotic pain medications, which have fewer negative side effects than intravenous drugs, prior to surgery, and are given sedatives before surgery to help the patient nap, but not lost consciousness. A continuous infusion of numbing medicine is pumped through a catheter near the surgical site for 48 hours to maintain numbness in the area, and more than 95% of patients experiencing pain after surgery are treated with oral pain medications like Tylenol. Patients who choose regional anesthesia report significantly less pain than those who opt for general anesthesia and narcotics, are out of bed sooner, and have shorter post-surgical hospital stays. These patients also typically begin physical therapy sooner.

This new protocol make surgery an option for older adults with complicated conditions that prohibit them from undergoing general anesthesia. 

Overall, the new protocol allows for less pain and a quicker recovery for patients undergoing hip and knee replacement surgery, and may soon replace the old protocol.