Leaving So Soon?
New Pain Protocol Reduces Length of Stay
for Joint Replacement Patients
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| Paul Rochmis |
Many joint replacement patients are discharged from Inova Fairfax Hospital as early as a day after undergoing joint replacement surgery. A major contributor is the “multimodal” pain management approach that surgeons have adopted.
“As a result of instituting this protocol, we have significantly reduced our length of stay and pain scores, and significantly improved patient satisfaction,” explains Robert Stinger, MD, PhD, Chief of Adult Joint and Reconstructive Surgery at Inova Fairfax Hospital.
The protocol, instituted at Inova Fairfax Hospital approximately three years ago, takes a proactive approach to managing postoperative pain. It involves the following steps, says
Dr. Stinger:
- Managing and shaping the patient’s expectations of the hospital experience. During the patient’s pre-operative visit in the office, the doctor explains that the patient will be comfortable enough to walk on their new joint on the day of surgery, and that there is a good chance that he or she will be sufficiently comfortable to be discharged the day following surgery.
- Administering pain medication before the patient arrives in the operating room. Prior to the operation, the patient receives a long-acting narcotic pill, a long-acting anti-inflammatory and an injection to prevent nausea. This helps to reduce the pain the patient experiences following the surgery.
- Regional anesthesia. Instead of having a general anesthetic, the patient receives a spinal anesthetic. The difference? Patients can breathe on their own and do not require a breathing tube. They are also more alert after the surgery and less likely to be nauseated.
- Use of a pain “cocktail.” Once the procedure is completed, but before the wound is enclosed, the surgeon injects a long-acting pain “cocktail” into the joint. The pain cocktail can last as long as two or three days and makes a big difference in a patient’s post-op pain.
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Robert Stinger, MD, PhD Chief of Adult Joint and Reconstructive Surgery at Inova Fairfax Hospital |
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Active Again
One patient who recently benefited from this new approach is Paul Rochmis, MD, a 72-year-old rheumatologist in the area. He had both knees replaced at Inova Fairfax Hospital in early December. “I explained to Dr. Rochmis prior to the surgery that since we were going to replace both knees at once, I would need to split the cocktail in half for each knee,” notes Dr. Stinger. “He had both knees replaced under a spinal anesthetic without a hitch, and was discharged to home three days after surgery.”
Within a few weeks following surgery, the active golfer, tennis player and motorcycle enthusiast was walking without pain and driving a car. “Every day I am pleased with my progress and am absolutely certain that I will reflect on this as one of the best decisions I ever made,” says Dr. Rochmis.
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