There’s No Place Like Home

As this recent article from the New York Times points out, the rehab facility (or hospital) is not the best place to recover from joint replacement surgery. 

You want to get out of the hospital as soon as you are stable and get home where (1) you won’t be exposed to a lot of sick people and (2) you’ll have a lot of incentives to keep active and move around – there’s a lot more interesting stuff to do at home. 

With modern anesthesia and pain management techniques requiring far less narcotics, people can go home faster feeling better than ever before. If you were living alone before your knee  replacement,you should be able to go right back to that (with some pre-planning of course. Someone will have to walk the dog and do the shopping for a few weeks).  

The majority of patients leave the hospital after a night or two. Some, with the proper support, can safely go home the same day.  The key to great rehab is to get you back to your daily routine ASAP, and build on that. 

Relieving Post Surgical Pain Without Narcotics?

Orthopedic surgery is painful.  There’s just no getting around the basic fact.  A lot of my patients, when they learn they need surgery, are more concerned about the pain, than the details of the actual surgery.  And almost no one really wants to be on narcotics.  Fortunately with multi-modal pain management (using smaller amounts of several medications rather than a whole lot of one) and regional anesthesia (blocking individual nerves and groups of nerves) the need for narcotics is a lot less than it used to be.

Every individual is somewhat unique in how they handle pain, and some of us need more medicine than others.  Some surgeries hurt more than others, too.  Most, but not all, orthopedic procedures will entail taking some amount of a narcotic, such as vicodin, for at least a day or two.  Some may not.  And it’s important to know that there are many strategies we can employ to try to minimize the use of narcotics – important for a lot of my patients who are allergic or just don’t tolerate them well.

I have several protocols that I use for various surgeries to try to make patients comfortable without overmedication.  These include the use of anti-inflammatory medications and milder pain relievers in addition to cold therapy and regional anesthesia.  Each of these approaches can be fine tuned for the individual.  When you are considering surgery, don’t be afraid to ask your surgeon about their plan for your pain relief.  Make sure your surgeon understands your concerns and your previous experience with medications so that together, you and your surgeon can come up with the best plan to keep you comfortable.

In my experience a team based approach allows for the plan best tailored to the individual, and in some cases for small procedures, allows a patient to manage without narcotics when that is their goal.