NHRMC patients benefit from advances in pain control

May 14, 2007
Cathy Butler knew more than most patients do when she faced surgery to replace her right knee. After all, she went through the same procedure four months earlier when doctors replaced her left knee.

But for the second operation, something changed. Butler’s medical team used one of the new pain management procedures in place at New Hanover Regional Medical Center’s Orthopedic Center at Cape Fear Hospital.

Anesthesiologist Thomas Dalton, MD, recommended a multi-modal approach to managing Butler’s post-operative pain. Instead of relying solely on general anesthesia and narcotic injections, doctors used a combination of medications for longer-lasting pain relief.

“It was like night and day,” Butler said recently. “I had much less pain. It was nothing at all like the first surgery.”

“In the past, you had general anesthesia and you woke up in pain after surgery,” Dr. Dalton said. “Whatever trauma happened to your tissue, you’re in pain, and we gave narcotics for relief. But now by incorporating local anesthesia and other techniques, that’s changing. The result is much better pain control.”

For years pain control centered on putting surgery patients to sleep under a general anesthesia and treating post-op pain with narcotic injections followed by several days of taking pain pills. New technologies and advancements have allowed doctors and anesthesiologists to explore new ways of managing pain. These individual protocols can often be tailored to patients when it is appropriate.

With some of the new pain management systems, patients are sedated for surgery with a smaller dose of narcotic. Anesthesiologists then use a local anesthetic to numb the affected area before, during and after surgery.
Dr. Dalton says using local anesthetics often lowers the amount of narcotics needed for the procedure, which also decreases the side effects such as nausea and vomiting.

Butler’s pain management included a pain pump. Dr. Dalton laid a catheter alongside the nerve in her right knee after the surgery. The pump slowly dripped the numbing medication into the joint for several days following the surgery.

“With the pain systems, less narcotic in the operating room means less side effect, which means quicker stay in the recovery room,” said Dr. Dalton. “In fact, many times we can bypass the recovery room because patients are more alert after the procedure than they would have been with a higher dose of narcotic. They can leave much sooner.”

Butler said she spent one less day in the hospital after her second knee replacement surgery. The pain pump also allowed her to tolerate the pain better. She believes it had a positive impact on her physical therapy following the second operation.

“When the physical therapist measured my movements, I was about 30 days ahead on my rehab compared to where I was after the first operation,” she said. “I was able to resist pain better, and that helped me recover quicker.”

Orthopedic or bone-related operations are among the most painful of all surgical procedures. While the pain management procedures are becoming more common in these surgeries, they are not limited to orthopedics.

“In general surgery we may lay the catheter in the wound where the surgeon has gone through the abdominal wall,” said Dr. Dalton. “Anywhere you’ve just operated you can use the catheter to slowly drip the numbing medicine in there and decrease the need for narcotics and make the patient more comfortable with fewer side effects.”

With pain ranking as one of the most important concerns of surgery patients nationwide, these advances in pain management are making a difference in the hospital experience.

“Pain, while a side effect of surgery, is not necessarily a benefit,” said orthopedic surgeon Kevin Scully, MD. “Anything we can do to better control pain, like using the pain pumps, will improve a patient’s rehabilitation and ultimately their recovery.”

“I have no doubt that the surgeon’s and anesthesiologist’s appreciation for pain control is increasing,” said Dr. Dalton. “Patients are doing better, with shorter length of stays in the hospital and they are not in as much pain. That’s good for everyone involved.”

Before your operative procedure, speak with your surgeon and anesthesiologist about possible pain management protocols that may be appropriate.