Multi Modal Pain Management: Making Hip and Knee Surgical Pain Easier

Perioperative pain management is a phrase that refers to how pain is handled after surgery. For hip and knee operations in particular, pain control regimens are designed to quickly lessen post-operative pain and get patients back on their feet as quickly as possible. Perioperative pain is caused by inflammation from surgical incisions, bone resurfacing, and soft tissue dissection that occurs with surgery.

Hip and knee replacements have traditionally been painful operations for patients because physicians have relied on opioid medications to target pain at one central location, including the use of pain pumps, nerve blockades and excessive narcotics. These methods of pain management can cause difficult side effects like nausea, sedation, confusion, risk of addiction and can also keep patients from mobilizing quickly after surgery.

A Better Cocktail for Pain

There are new perioperative pain care approaches that we are now using in hip and knee surgeries known as multimodal pain management, or analgesia. By strategically administering medications before, during and after surgery, targeted at different pain pathways, we can better control pain and decrease the body’s dependence on a single medication. Ultimately we want to use the best combination of medications that target different receptors in the body that will have beneficial effects on pain control.

Examples include a pre-operative spinal anesthetic, and an injectable medication that we refer to as a cocktail that allows us to deliver specific medications locally at the time of surgery. Perioperative pain cocktails benefit patients early in the post-op period and allow them to get up and walk on the same day of surgery.

Multimodal pain regimens will vary from patient to patient, but they all have the same benefits:

• Help ensure that patients experience as little pain as possible.
• Minimize the use of narcotics.
• Help patients get on their feet and recover quickly.

Although hip and knee replacement surgery isn’t painless, these techniques allow for better pain control post-operatively.

Dr. Keith Fehring is a hip and knee surgeon at OrthoCarolina’s Hip and Knee Center.