New way to manage pain after knee replacement surgery

“Despite many technological advances, pain management after total knee orthopedic surgery can be challenging,” says Kwan “Kevin” Park, MD, orthopedic surgeon at Houston Methodist. awake; most patients experience significant pain and discomfort, especially during the first few weeks of recovery”. “Medical infusion, which involves injecting drugs directly into the bone marrow, allows us to control pain in advance so that patients don’t have to take a lot of pain medication later on.”

Total knee replacement is the recommended treatment for the relief of chronic pain caused by damage to the knee joint caused by arthritis or injury. According to the U.S. Joint Replacement Registry Annual Report 2021, major knee replacement surgeries account for 54.5% of the nearly two million hip and knee replacement surgeries performed since 2012 to 2020.

Despite the high frequency and favorable outcomes of surgical procedures, soft tissue manipulation and bone resurfacing damaged during knee replacement are painful in the early postoperative period.


“Twenty years ago, patients would stay in the hospital for a few days after surgery and receive extremely high doses of narcotics for post-operative pain relief,” says Park. “But there’s been a paradigm shift; patients are usually discharged the same day after knee replacement surgery, and we use multimodal pain management techniques that work much better to control pain and need less drugs.”

These multimodal regimens often include a combination of drugs, such as nonsteroidal anti-inflammatory drugs, opioids, and neurostimulants that act on the nervous system, he added. both before and after surgery. However, opioid medications, while very effective at relieving pain, have side effects such as constipation and nausea, and some people are allergic to opiates. Opioid drugs can also be highly addictive. Furthermore, there is a lack of consensus on the optimal preoperative procedure for pain relief.

Previously, researchers have demonstrated that injecting the antibiotic vancomycin directly into the tibia before surgery reduces infection by achieving higher drug concentrations in the knee. Driven by this success, they investigated whether adding morphine to the tibia with a standard antibiotic solution could improve pain control after surgery.

For the study, the research team included 48 patients who needed total knee replacement surgery. Of these patients, half were randomly assigned to receive vancomycin and morphine injected directly into the bone marrow, using an infusion device inserted into the tibial tubercle region. The rest were given vancomycin only. After surgery, the researchers monitored the patients’ pain, nausea, and opioid use for up to 14 days after surgery. Park’s team teamed up with Dr. Francesca Taraballi, assistant professor of orthopedic surgery and director of Houston’s Center for Musculoskeletal Reconstruction, to measure serum levels of morphine and an inflammatory marker called interleukin-6 in all study participants for the next 10 hours. work.

After analyzing their data, the researchers found that patients who received intra-tibia morphine injections had lower pain scores after knee replacement than those who received no replacement. This is effective for up to two weeks after surgery. Furthermore, these patients also reported less pain for several days even though they had similar levels of the inflammatory marker interleukin-6 as controls. Taken together, although patients who received analgesia delivered directly to the tibia during surgery had comparable inflammation, these patients received less analgesia after surgery.

Park notes that direct infusion of this opiate into the bone marrow during surgery may even facilitate faster recovery of the knee joint.

“By infusing pain medication immediately, we can reduce post-operative pain for up to two weeks, reduce the amount of pain medication a patient needs and possibly even improve head function,” he said. pillow over time. “Our technique could also improve the multimodal pain treatment we’ve been using for knee replacements for many years.”

Source: Newswise

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