From left, back are Orthopedic Surgeon Luc Perrier, Operating Room Registered Nurse Lisa Mcdonald, Orthopedic Surgeon A. Martin Clark, Jr.; front, Medical/Surgical Registered Nurse Kate Kramer, Orthopedic Surgeon John Savage, and Operating Room Director and Registered Nurse Jeanette Dempsey.
POTSDAM -- Canton-Potsdam Hospital has introduced new procedures designed to reduce pain after total knee replacement surgery.
The new pain medicine protocol is modeled on those currently in use at New York University’s Langone Medical Center in New York City and Johns Hopkins Hospital in Baltimore, MD.
The protocol has been introduced following research into best practices at leading surgery hospitals and centers, feedback from patients and consultation with orthopedic surgeons.
“We routinely visit patients post-operatively as a team,” said Lisa T. McDonald. “Our patients were telling us their pain was not well controlled and we knew we had an opportunity to improve. The research pointed toward a multimodal pain management protocol for total joint patients,” said McDonald.
McDonald worked closely with A. Martin Clark, Jr., a Columbia University and New York Presbyterian Hospital-trained orthopedic surgeon at CPH, and with Jay Delisle, clinical pharmacist at CPH, who refined the protocol and established standard order sets, which are tools medical professionals use to give directions for patient care.
John Savage, who practices with Dr. Clark, and Luc Perrier, a CPH-affiliated orthopedic surgeon with a subspecialty in pediatric orthopedic surgery, have also worked on the protocol. All professionals involved in the care of patients undergoing total knee replacement surgery are already using the protocol. Some of the medications are also improving pain control for total hip replacement, orthopedic trauma and sports medicine patients.
“We hope that our new protocol will dramatically improve pain control, both at rest and with motion, provide better patient satisfaction and improve early postoperative rehabilitation,” said Dr. Clark. This new pain protocol was the collaborative effort of medicine, nursing and pharmacy and took almost a year to develop and implement. It employs multiple modalities before, during and after surgery, with careful attention to minimizing or completely avoiding common side-effects of using IV narcotic pain medication alone, such as respiratory depression, postoperative nausea and vomiting, over-sedation, and itching.
Pre-operatively, patients receive doses of specific pain relievers; spinal anesthesia is used in most cases. During the operation, the patient receives other pain relievers and may receive an intra-articular block, which is a “cocktail” of specific drugs injected into the knee. In the post anesthesia care unit, a polar care device is applied to the knee to provide continuous cold therapy. Post-operatively, scheduled doses of medications started before and during surgery are continued, including twenty-four hours of IV administered Tylenol.
“Initial results are very encouraging,” said McDonald. “Patient, nursing, and physical therapy responses indicate patients need very little, if any, narcotic pain medication administered intravenously. Physical therapists are reporting better muscle contraction following surgery, speeding up rehabilitation,” said McDonald. “When patients are able to get out of bed and move around sooner, fewer infections occur, and fewer complications develop. Some complications can have severe consequences for the patient, and can be costly for patients and the health system as a whole, so reducing these is especially important. Developing best practices enhances medical standards and healthcare generally, as well as helping our patients here locally. We’re always studying ways to improve care,” she added.