Home' The Source : Second Quarter 2018 Contents When Jeffrey Hodrick, M.D., an orthopedic
surgeon at the Southern Joint Replacement
Institute (SJRI) in Nashville, Tennessee, con-
sults with a patient about knee or hip surgery
and its aftermath, he discusses how multi-
pronged approaches to pain management can
be part of an Enhanced Recovery After Surgery
Some of his patients are adamant about
what they don’t want after they receive a joint
replacement—opioids. Wary of becoming addicted and fearful
of nausea and other side effects, these patients are eager to hear
Hodrick, who also serves as a HealthTrust Physician Advisor,
explain new ways to help them attack and control pain without
relying on these narcotic painkillers. Though some patients are
ready to avoid narcotics, others need more convincing to try new
approaches, particularly older adults recovering from a significant
joint replacement who might have more difficulty with the clinical
mandate to get up and moving as quickly as possible.
Regardless of the patient population, education is the key to
unlocking a successful ERAS and multimodal pain management
strategy. Hodrick offers the following guidelines for health systems
wanting to provide alternate options for pain control.
1Educate and help set expectations. SJRI starts the process by
offering patients preoperative classes to explain the magnitude
of their upcoming hip or knee surgery. Hodrick tries to manage his
patients’ expectations about the pain and inflammation involved
and the length of the recovery.
“It is important to be honest,” he says. “You provide better quality
care when you help patients know what to anticipate.”
2Use non-narcotic medicines in the perioperative period.
Hodrick’s team applies anesthetic techniques, with an emphasis
on neuraxial and regional blockades, to provide initial pain relief
to patients while reducing their potential complications and side
effects. During a knee replacement, for instance, the anesthesia
team numbs the patient’s leg while she is under a spinal anesthetic,
allowing the patient to breathe on her own rather than through a
tracheal tube. The nerve block provided by the regional anesthesia
helps alleviate pain for the first 18 to 24 hours after the procedure.
Hodrick’s team also administers periarticular block medicine,
an anti-inflammatory drug that reduces swelling in the soft tissue
around the joint. This allows patients to start moving soon after
surgery, preferably within five hours. Taking those initial steps so
quickly allows them to clear a big physical and psychological hurdle.
“If you can get the patient up and walking and bending their
joint without significant discomfort, you are sending an impor-
tant message. You are telling the patient, ‘OK, we can do this,’”
Hodrick says. Steroids are also given to reduce the inflammation
and control nausea.
After surgery, some patients use a battery-operated TENS
(Transcutaneous Electrical Nerve Stimulation) machine to modu-
late the pain response, or nerve conduction, to the brain. Hodrick
also recommends combination therapy using over-the-counter
pain relievers to help alleviate pain or discomfort.
“I am a big believer in Tylenol,” he says. “It is a good, benign
agent, and people can get the maximum benefit when they take it
on a regular schedule,” he says.
3Cut down on opioid prescriptions—within reason. Hodrick
underlines the point that eliminating or significantly reducing
the use of opioid medications for pain management can enhance
recovery time, without the negative side effects often experienced
with opioids. However, he realizes that, despite the many available
pain-relief techniques, some patients may still suffer pain, especially
after a knee replacement. National headlines warning of the risks of
opioids have led to more awareness of abuse, but they also chased
away some patients who could benefit from them.
“There is a huge pendulum swing,” he says. Though controlling
opioids is necessary, “cutting opioids out completely is not appro-
priate for all patients having major surgery.”
4Encourage proper disposal of opioids to decrease diver-
sion. When he does prescribe narcotic painkillers, Hodrick
SOURCEBOOK PAIN MANAGEMENT PERSPECTIVES
New Plans for Pain
A Joint Replacement Surgeon’s Perspective
on Multimodal Pain Management
Continued on page 22
Jeffrey Hodrick, M.D.
20 The Source | Second Quarter 2018
4/17/18 8:27 AM
4/17/18 8:27 AM
Links Archive First Quarter 2018 Third Quarter 2018 Navigation Previous Page Next Page