New Continuous Anesthesia Eases Pain
The newly implemented Continuous Regional Block Program at St. Vincent’s Medical Center is having a positive impact on the patient care experience after orthopaedic surgery. Patients who select this form of pain management are better able to handle the first sessions of physical therapy recommended soon after surgery, which have traditionally been painful.
“Continuous anesthesia can dramatically reduce pain and the risk of postoperative surgical stress,” said St. Vincent’s Chairman of Anesthesiology Thomas R. Bladek, MD. “It has fewer of the side affects associated with other pain medications and reduces the length of hospital stays, thus lowering costs.”
An Efficient Delivery System The continuous anesthesia process involves an initial needle stick to numb the area where a catheter will be inserted to deliver nerve-blocking medication during surgery. “The tubing carries medication to the site for two to three New Continuous Anesthesia Eases Pain days,” said David Y. Lo, MD, an anesthesiologist who recently joined our staff at St. Vincent’s.
“This is a great improvement over oral or IV pain medication in that it specifically targets the nerves involved.” Dr. Lo’s expertise with this type of anesthesia reflects the more than 3,000 peripheral nerve blocks/catheterizations he has performed within a three-year period.
“Putting the catheter in takes only a few minutes,” he explained. “The patient feels a bit of pressure, and fairly soon anesthesia takes over as the surgery begins and throughout the next couple of days.”
The pump delivers nerve block to the site according to how long the patient has chosen, up to three days. “It’s important to know that nothing can ensure a 100 percent painless experience,” Dr. Lo said. “But on a scale of one to 10 for pain, this drops the pain to a substantially lower number.”
Good News for Joint Replacement Patients
“Bones have nerves, and joint replacement involves multiple cuts in each of the three bones of the knee,kneecap, thigh and shin bones,” said Peter S. Boone, MD, an orthopaedic surgeon on staff at St. Vincent’s. “It’s traditionally one of the most painful surgeries. Being able to offer patients this form of anesthesia is therefore extremely helpful.”
Dr. Boone agreed that most other pain medications produce side effects not seen with continuous anesthesia.“Patients can have nausea, vomiting, disorientation and urine retention,” hesaid. “This method of sedation assists in getting patients up faster, when the pain would otherwise be at its worst.
Once the catheter is removed, regular medication is taken to help with pain.” “The aim is to afford our patients at St. Vincent’s effective surgical solutions to joint problems that disrupt their lives with pain and discomfort,” said Dr. Bladek. “The Continuous Nerve Block Program plays a significant role in achieving that goal.”
A Patient’s Perspective on Surgery with Continuous Anesthesia
Patricia Papeika of Derby, CT, knew she was due to revisit knee surgery, which she had some 35 years before. Operations to correct the serious misalignment of her legs had left pins behind in Papeika’s right knee, but both knees had been giving her increasing trouble in recent years.
“My right knee in particular was agonizing,” said the special education teacher whose style of teaching includes “getting on the floor to play with my kids—whether it’s crouching to illustrate something or adjust a brace. Whatever helps them learn or just feel comfortable, that’s what I do.”
By the spring of this year, simply climbing stairs in her two-story home was excruciating. “I’d hear this
crunching sound whenever I bent my knee,” Papeika said. “Believe me, I didn’t want to go through joint surgery again, but I knew it was time.”
She consulted Peter Boone, MD, an orthopaedic surgeon on staff at St. Vincent’s. “Turns out, I’d
been walking around for the last three or four years with just about no cartilage left in my right knee.
Dr. Boone told me about different anesthetic options I’d have at St. Vincent’s, including something new called continuous anesthesia. Having had joint surgery before, that one sounded right for me.”
“That 48 hours of not worrying about pain right after the surgery was so important,” she said. “I was up for the exercise class the next day and had physical therapy for the three days I spent in the hospital. By then the continuous anesthesia was finished, so other pain medications took over.”
After receiving in-home physical therapy five times a week for range of motion and weight-bearing exercises, she says “I’m on my way to complete healing. Then I’ll start thinking about getting my other knee done using the continuous anesthesia program they’ve developed at St. Vincent’s.“