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Pain management critical to joint replacement by Dick Peterson Public Relations “Exquisitely painful” is how anesthesiologist Jay Gottesman, M.D., describes joint replacement surgery.   That’s why effective pain management is critical, certainly during the operation, but critical also to the success of the rehabilitative physical therapy that follows.   “Bone and joint procedures can be exquisitely painful, but with the pain management techniques available to us, there is no reason for patients to dread joint replacement surgery,” Gottesman said. “By assembling a team of anesthesiologists who have expertise in the special pain issues involved in joint replacement surgery and its subsequent rehabilitation, MUSC’s total joint program is years ahead of similar programs offered at other Lowcountry hospitals. The point is,” Gottesman said, “we are providing state-of-the-art pain control and have a specific acute pain management team here. That makes MUSC the place to come for total joint surgery.”   Combine these analgesic techniques with the latest in minimally invasive knee replacements and these patients will need only a 23-hour admission with appropriate follow-up. “That’s not to say there isn’t any pain,” said nurse Linda McDonald, operations coordinator in the 2 East Joint Replacement Unit. “You’ve replaced a hip or a knee and it’s going to hurt.” She explained that the discomfort patients feel usually comes when one pain control technique is replaced by another as the patient progresses into the recovery phase and continues physical therapy.   McDonald, who opened the joint replacement unit in 2002, said that patients benefit from a unit that specializes in joint replacement. She said that by focusing on the special needs of joint replacement patients, nurses and therapists can coordinate their activities. Nurses can be certain a patient’s pain medication is on board and ready for a physical therapy session. “Our staff takes a lot of pride in its quick response to call bells, anticipating issues in patient recovery and pre-planning nursing care,” McDonald said.   From the orthopaedic surgeons and anesthesiologists to the educators, nurses and therapists, the bone and joint program meets patient needs from start to finish. The program even includes an annual bone and joint reunion, an informal opportunity for former patients and their doctors, nurses and therapists to review their recovery and address any issues that may have arisen.   Gottesman said that joint replacement begins with an orthopaedic work-up during which the patient is introduced to the details of the procedure, how it is performed and its expected outcomes. It’s during this time that decisions are made, a schedule is set and consent is given.   “In the pre-op clinic, the anesthesiologist will answer questions and develop a protocol to include the choice of anesthesia,” Gottesman said. “We’ll explain how it works, how it is administered and what else is going on.” On the day of surgery, the anesthesiologist and surgeon review the plan to be followed before, during and after surgery and the pain block to be used. During the pre-op visit, patients also see the orthopaedist, the hospitalist, meet the nursing and therapy staff and attend an educational class. During the class, patients learn how to prepare for surgery before they come to the hospital, what to expect each day they are in the hospital and finally what they will need to prepare for the return home.   “It’s a one-stop shop for your joint replacement needs,” McDonald said.   In recovery and a few hours later in the specially equipped and staffed unit for total joint replacement patients, pain management becomes an essential factor in rehabilitation.   Physical therapy begins almost immediately.   “You don’t get a new joint to let it sit there for three days,” McDonald said, explaining that it has to begin moving to restore strength and range of motion. This also allows the muscle and soft tissue to begin healing and enables the joint to approximate into its space. Some restrictions include resistive exercise such as bicycle riding and wearing ankle weights when walking.   Gottesman said that physical therapy, employed shortly after the operation, will lead ultimately to a more functional joint. Without effective pain management, physical therapy would be impossible. “If the therapy in the short term is done well, we’ll achieve a better result later.”   “Upon discharge, a joint replacement patient receives physical therapy at home for about two weeks, returns for a check-up and then may receive outpatient therapy as needed,” McDonald said. ”We love to hear our patients tell us about all the things they can do that they couldn’t do before.”    The Second Annual Joint Replacement Reunion and Golf Tournament is set for Oct. 21. The golf tournament will be at the Patriots Point Golf Links and the reunion at the Shrine Temple in Mount Pleasant.   For further information on the MUSC Bone and Joint Center, call 573-1539.       Friday, Oct. 14, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.