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Dr. Jacob

Physiotherapist, Rajahmundry

100 at clinic
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Dr. Jacob Physiotherapist, Rajahmundry
100 at clinic
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Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences....more
Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences.
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Total Knee Replacement - Multimodal Pain Relief After Surgery!

MBBS, DNB (Orthopedics)
Orthopedist, Pune
Total Knee Replacement - Multimodal Pain Relief After Surgery!

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:

  1. 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.

  2. 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.

  3. 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.

  4. Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

  5. 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.

  6. 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.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2577 people found this helpful

I have a knee joint pain for the past 3 months. What should I do? i'm a 26yr old female.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Faridabad
I have a knee joint pain for the past 3 months. What should I do?
i'm a 26yr old female.
1. Go for fasting once a week. You can go for absolute fasting or rely on a liquid diet to digest ama (toxin). Fasting should be followed by hot fomentation or by taking a bath with lukewarm water or steam bath. 2. After fasting and fomentation, mix powdered long pepper, black pepper and dried ginger in equal quantities and take 1 teaspoon of this powdered mix with lukewarm water twice a day. This will help you restore your digestive fire. 3. Take one tablespoon of castor oil before going to bed, once or twice a week. It helps in cleansing ama (toxin) build up and balancing vata. 4. Mix equal quantities of powdered fenugreek seeds, turmeric and ginger powder. Take one teaspoon daily in the morning and evening. 5. For dry fomentation of the affected joints, take a cloth and fold it into four, fill it with hot and sand make a potli (bag) out of it. Use this bundle for the fomentation of different joints. This is very helpful in reducing pain and swelling.
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I have knee back pain from last three days. I have ACL reconstruction in 8th August 2017.

ms orthopaedics, mbbs
Orthopedist, Noida
I have knee back pain from last three days. I have ACL reconstruction in 8th August 2017.
Perform regular knee exercises. Apply ice packs locally. Medications like Enzomac will help. ACL reconstruction and backside knee pain are unrelated.
1 person found this helpful
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I am 16 year old and male and have backache for last 2 month l have used pain relief cream cream for couple of days but have not got any relief what should l do now.

MPT, BPT
Physiotherapist, Noida
I am 16 year old and male and have backache for last 2 month l have used pain relief cream cream for couple of days b...
Apply hot fomentation twice daily. Avoid bending in front. Postural correction- sit tall, walk tall. Extension exercises x 15 times x twice daily. Bhujang asana. Core strengthening exercises.
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Sir my job is sitting. And my both hip joint surgery have done before two year. My problem is my sexual stamina is low. please help.

D.A.M.S( A. M.), D.AC/B.E.M.S
Acupressurist, Mumbai
Sir my job is sitting. And my both hip joint surgery have done before two year. My problem is my sexual stamina is lo...
You should take acupressure therapy take biochemic ferrum phos 12x + kali phos 12x, 4 tab each thrice aday with warm water and take it 5 days
2 people found this helpful
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Hi sir. I underwent arthoscopy for my left knee for lateral minicus tear on 29th sep 13. since then I have problem while prolong sitting in office. Bike ride etc. it's always painful and I feel more or less pain 24/7. Now I am having two medicines tendocare And Elkar 0.5 g Past 3 months. However the flexibility n volume of pain had reduced past one month BT it's never cured. I wonder if I can be normal as I was before surgery or injury. I got injury on 25 July 11 while playing football. Thanks

MSPT (Master of Physical Therapy), Bachelor of Physiotherapy
Physiotherapist, Faridabad
Dear, Very Good Evening! Thanks for writing in regards to your problem with good description of your symptoms. Much appreciate it as it helps to make our responses more specific as well. All the symptoms you have mentioned make me suggest of few areas that me need possible addressing after a thorough clinical assessment has been carried out. However, there may be possible two things which may be going on simultaneously or either one of them which may be resulting in the symptoms you are experiencing. These 2 things i suspect may be: 1) Capsular tightness post-arthroscopy 2) Tight Hamstrings Most of the times, arthroscopic procedures for lateral mensical tears are successful (varying on how complex it was & if any pre-existing wear & tear changes present or not). A good rehabilitation of minimum 3 months is must to facilitate the recovery and aid you to return to sport. So Manish, take this opportunity and momento to get a further detailed assessment specially with a Physiotherapist with Sports experience. Depending on where you are based, I may be able to provide you with reference for the same if I have anyone within my contacts. I have seen many similar post menisectomy clients with a good outcome following a specially designed exercise and treatment program. So, I am looking for a good recovery in your possible given scenario. I take this opportunity to wish you good health and a return to football this year. Best Wishes
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Hello Sir, I visited your clinic 12th Jun 2016. I was having sever back pain. I took your prescribed medicine. Now my back pain is gone. But still I am having problem in sitting, I have pain in spinal cord tail and also some times in legs. What could be the reason and solution. Thanks, Ritu.

MPT - Orthopedic Physiotherapy, BPTh/BPT
Physiotherapist, Noida
Hello Sir, I visited your clinic 12th Jun 2016. I was having sever back pain. I took your prescribed medicine. Now my...
Seems coccyxgenia so x-ray must firstly then tk physiotherapy treatment tens and ultrasonic therapy tk soft pillow in sitting time avoid long sitting and do stretching exercise of spine and legs.
1 person found this helpful
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My father is suffering from joint pains. Nearly from seven years he had gone to many hospitals for consulting. But no results and used many tablelts given by doctors.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
My father is suffering from joint pains. Nearly from seven years he had gone to many hospitals for consulting. But no...
It requires detailed investigation and examination. Preliminary investigations suggested: hb, tlc, dlc, esr, blood sugar fasting & pp, uric acid vit d urine r/e x-ray of the affected part. Anyway it may be tried sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick mattress are harmful use no pillow under the head. Do hot fomantation paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back, knee & general exercises. It may have to be further investigated. Do not ignore it. Let it not become beginning of a bigger problem. Make sure that patient is not allergic to any of the medicines that he/she is going to take. If it does not give relief in 4-5days, inform.
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I am 72 years old female living in Mumbai-India. I am having problems of severe pain while walking climbing up and down etc/Doctors have advised me knee replacement surgery for both knee at a time. Do you suggest any alternative treatment of permanent nature and surgery of both keens safe and good at the same time. I am non diabetic and B.P. Is near normal. I weigh at 73.3 kgs and height of 5 ft. 2" Thanks.

master in neuro Physiotherapy, bachelor of Physiotherapy
Physiotherapist, Zirakpur
I am 72 years old female living in Mumbai-India. I am having problems of severe pain while walking climbing up and do...
Before surgery take Physiotherapy treatment for few day and after surgery also you should go for Physiotherapy treatment at least for 45 days. If knee are suffering from severe arthritic changes and pain then go for surgery.
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