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Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.
Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:
Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.
Patient Controlled Analgesia (PCA): This method is also known as ‘Pain Pump’. An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.
Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.
Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.
Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.
The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.
I am unable to gain weight. I have consulted many doctor but inspite of that I was unable please help me. Sir.
Dr. I am 21 years old and my weight is only 49 I feel very skinny, I want to gain some weight please suggest me something that can help me with no side effects.
Total knee replacement is arguably one of the most successful of Orthopaedic surgeries. The success has been documented at various scientific platforms and Journals.
However there are still many myths in the mind of the lay person who is suffering from this crippling problem and prevents them from getting treated for the same.
- Myth : Everyone suffers from Knee arthritis, I should learn to live with it.
Fact: If the Knee pain due to arthritis is so much that is affects activities of daily life, and you find yourself refusing to participate in routine social activities, Knee replacement could be the best option to bring back the lost zeal in your life.
- Myth: I am too young for this surgery
Fact : Joint Replacement is no longer just dependent on the age. Recent advances in materials and design have vastly extended the boundaries for joint replacement.
- Myth: I am too overweight for this surgery
Fact : Surgery is not dependent on the weight, but on the overall medical condition of the person. In fact after the surgery, the ease of movement means losing weight may become easier.
- Myth: I should try to postpone the surgery as much as possible.
Fact : Severity of Knee arthritis can sometimes be so crippling that even small daily activities like going for a walk in the garden , shopping at the market or in the mall can become unbearable. This causes a great loss in the quality of life for that person. Pulling on in such circumstances is not only physically more challenging but may cause emotional issues and depression. In such circumstances joint replacement can be a life changing surgery