Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

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.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

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.

Multimodal Pain Relief After Total Knee Replacement

Drug addiction is a major problem in today's world. The major part of these drug abuse victims are teenagers. There are several reasons may drive your teen kid to hard drugs which include peer pressure, neglect, curiosity or just for the sake of being cool. This could be a major concern for the parents whose children get addicted to drugs but an important thing to keep in mind is that the only person who can help your kid overcome addiction are the parents.

Here are a few measures that can help your kid overcome drug addiction:
1. In order to put your kids on the right path, the most important thing is to show them love. You should keep aside your anger, fear and grief and approach them. Tell them why you are scared or angry. Proper love and affection is required to bring your kids back to the normal track.

2. Try to find their strengths and weakness. Your child should be complemented for any good thing he or she does. You should observe them properly and try to perceive their current nature and mental state.

3. You should try to keep your calm and talk to them instead of scolding, shouting or threatening them. You must also listen to them carefully and try not to react in any way. Talk to them about your concerns and see whether they are cooperating with you.

4. Getting your kids involved in some activity, which will let them mix with a different group of peers will be a positive remedy. You have to make them feel good about themselves. Try to find ways so that your kids will get into some positive, productive activity.

5. Fixing an appointment with a psychiatrist who deals with drug abuse situations can also help you deal with the issue. You must explain to your kids that there is an obvious reason behind their addiction, and it must be solved for their own good.

6. You should also connect with the counselors at schools and colleges. They have seen many cases like your child s and know about the situation well. You can enroll your kids in a substance abuse program which is connected with his school.

7. You must tell your kids that what they are doing is risky and illegal and as parents, you have the right to help them overcome this in order to maintain good health, and that you do not want them to go to prison.

8. Find an expert therapist specializing in teen substance abuse and make your kids have weekly appointments with him. A good therapist knows the best ways to guide your kids to the right path.
Drug addiction in kids is a common syndrome these days. If your kid is into hard drugs, you need to do your best to save him and help him overcome the addiction.

How to Help Your Kids Overcome Addiction?

Both women and men suffer from infertility troubles. There are a host of causes that may lead to infertility in men such as lifestyle choices and obesity. Male infertility is characterized by irregular sperm function or reduced sperm count. Infertility has emerged as a common problem as a result of the modern day lifestyle. Extremely hectic schedules, stress, burnout, depression, unhealthy diets; all of these can contribute to fertility issues.

The various reasons for infertility in men are:
1. If you are overweight, then it is time to lose those extra kilos. Obesity leads to a number of health problems, one of them being erectile dysfunction.
2. Various hormonal problems such as complications of the hypothalamus, pituitary and adrenal glands may lead to low testosterone levels in the body.
3. Various infections such as inflammation of the testicles and epididymis that causes blockage of the tubes carrying the sperm can be a cause.
4. Various medications such as using anabolic steroids, antifungal medications and chemotherapy may hamper production of the sperm and thus hit fertility.
5. Both alcohol and cigarettes may cause problems in sperm production, and cause erectile dysfunction. Excessive drinking may lead to complications in the liver resulting in infertility.

The reasons of infertility may range from medical causes to lifestyle choices; some of the causes may be related to the environment. A common cause of infertility is due to problems with transportation of the sperm. These are mainly due to blockages in the tubes that carry the sperm.

Symptoms of infertility in men are:
1. You may experience low libido
2. Your sperm count may be low
3. You may experience lumps or swellings in the testicles
4. Chromosomal complications such as reduced body hair
5. You may have chronic respiratory problems.

What Causes Infertility in Men?

Hematuria is the medical name of what is commonly known as bloody urine. It s an unpleasant and particularly painful feeling where the discharge of urine from your system is either cola coloured with blood clots or just a light shade of pink. It varies in visibility, that is, it can either appear to the naked eye or it may only appear under a microscope when a sample is examined. If it isn t easily visible then it can only be detected as a part of your regular check-up as the symptoms are more often than not invisible. Which is why it is very important to get a full body check-up done as often as possible.

Hematuria is an indicator of other serious conditions that could be underlying and not easily apparent. You should not sit on it and definitely visit your doctor if you notice something similar or if you feel any sort of discomfort while urinating. The number of reasons that can cause bloody urine are:

UTI: Urinary tract infection is one of the reigning causes of most renal and gynaecological problems. It is when your urethra and bladder are affected and it causes a perineal urge to urinate which is also a painful experience. Along with this your urine might carry a strong stench. Bloody urine, in this case, is not visible to the naked eye so you have to go in for a check-up as soon as the other symptoms arise.
Stones: Stones in your bladder or kidneys are caused due to the accumulation of minerals from highly concentrated urine. These harden over time and become stone-like. Kidney stones are extremely painful and can cause bleeding both microscopic and visible.
Exercise: Exercise should be practised in moderation. If you are not used to regular exercise then the first time you start, take it slow and gradually build up from that point onwards. Even then, if after a workout you see blood in your urine, then visit your doctor immediately. It is rare for exercise to cause bleeding but it can be the trigger to other problems that might be the actual culprits behind the bleeding. If you have any injuries in your kidney from working out or from contact sports then you are likely to see blood in your urine.
Prostrate: This is a problem aging males are likely to face no matter how active and healthy a lifestyle they lead. The prostate gland can sometimes get enlarged and cause obstruction in the flow of urine by pushing the urethra into a compressed corner, as the prostrate takes up more space than is allotted to it. The signs include microscopic bleeding but also a painful need to urinate perpetually. There may also be a visible bloody discharge of urine.
Thus, hematuria can be sneaky or it can come with ringing bells. Either way, it is best to not avoid going to the doctor and most importantly get regular check-ups done for your own health and safety.

4 Underlying Causes Of Hematuria!

6 ways to minimize visible pores on your skin

Pores are openings in the skin through which your body's natural oil, called sebum, is released. They appear larger when they are clogged with dirt or oil, and are home to hair follicles. Dead skin cells and sebum which, put together, form a pimple can stretch out pores. Aging and exposure to the harmful UV rays of the sun also contribute to the appearance of pores on your skin. Pores can be controlled with the right skin care. 

Here's how:
1. Choose your skin care products wisely 
Zinc and magnesium help to maintain your skin's oil balance and clear pores. Products with softening ingredients like rosemary and lavender may soothe your skin and prevent pores from stretching out. You should use products with salicylic acid as an ingredient since it unclogs pores, exfoliating your skin. 

2. Maintain cleanliness
Washing your face temporarily stops your pores from holding extra oil or dirt. Exfoliating two to three times a week can also control the cropping up of pores on your skin. However, these are temporary methods because you will have large pores naturally if your skin is oily.

3. Applying sunscreen
Exposure to the harmful UV rays of the sun for too long can make your pores look bigger. Applying sunscreen on the face and on exposed areas of your skin with SPF 30 can minimize your pores. Also, wear a broad-brimmed hat and withdraw stepping out in the sun between 10 A. M. To 4 P. M.

4. Treating the spot
Oily skin tends to have larger and more noticeable pores. Some areas of your face may be oilier making the pores visible. A clay mask can be used for spot treating if the pores on your nose, cheeks or forehead are large. Apply a thin layer of the mask on your skin and rinse it off with water after a few minutes. The clay extracts the extra oil out of your clogged pores so that the skin looks sleek. Using blotting paper on your oily areas can also be effective. 

5. Maintain a proper diet
Avoid food that is oily and high in fat because unhealthy oil can agitate the skin leading to clogged pores. You should eat low-fat foods like fruits and vegetables instead of munching on chips, cookies and candies. 

6. Remove makeup before going to bed
One of the biggest blunders that you can do is to leave your makeup on and go to bed. Leaving makeup on clogs your pores, stretching them out over time. Even if you forget to wash off your makeup at the sink due to some reasons, make sure that you at least remove it with face wipes. 





6 Ways to Minimize Visible Pores on Your Skin

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

Don't wait any longer, manage your Kayachikitsa Specialist online with a Lybrate doctor today

Consult for Kayachikitsa Specialist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES