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Our Pain Management Advantage
Pain Management and Rehabilitation After Joint Replacement
Like every patient, you too have the right to expect pain management to include, but not be limited to:
Although it is very rare, the bloodstream carrying infection from another part of the body can infect an artificial joint. Therefore, you should ensure that your doctor treats every bacterial infection, like pneumonia, urinary tract infection, abscesses, etc., promptly. Routine colds and flu, as well as cuts and bruises, do not need to be treated with antibiotics.
If you have questions, it is advisable for you to ask your physiotherapist before you leave the hospital. Your surgeon may also have additional instructions for you to follow upon discharge. Remember to record them as a reminder.
You should also practice relaxation exercises, such as slow rhythmic breathing, to handle any pain you may be feeling, as well as to provide overall comfort. Here's a quick guide to a breathing exercise:
Like every patient, you too have the right to expect pain management to include, but not be limited to:
- A concerned staff committed to pain prevention and management
- Information about pain and pain relief measures
- His/her reports of pain to be respected
- Health professionals responding appropriately to reports of pain
- Availability of pain relief specialists
To ensure an effective treatment, you should:
- Request pain relief on a timely basis
- Work with your doctor and nurses to develop a pain management plan
- Help your doctor and nurses assess your pain and report whether the pain relief measures were effective
- Talk to your doctor and nurses about any worries about taking pain medication
As there are no direct clinical tests to measure your pain, it is important that you express to the staff how your pain feels like, where it is located and if it changes at times. This will help your doctor plan your treatment. During such discussions, you will be asked to rate your pain by using one of the pain scales. Since your pain levels may change at times even while you are on your personal Pain Management Program, remember to tell your nurse if it becomes worse.
For immediate relief from pain after surgery, you will be given pain killers by either injections or by Continuous Epidural infusion. With either method of pain medication, please do notify your nurse or doctor if you are not getting pain relief.
A day or two after your surgery, you will be switched to oral pain medication. This is because by this time, your surgical pain will be reduced and you will be able to progress with various activities more readily. Oral pain medication will help you resume daily activities with a minimum amount of discomfort. Our rehabilitation staff will assist you in a speedy recovery from your surgery.
If you need additional pain relief, your physiotherapist can provide you with Cryo cuffs or other cold therapy and introduce you to helpful relaxation exercises. Cold therapy in the form of ice packs or another cold therapy method will be provided as an intervention to reduce swelling and pain. This therapy produces an anesthetic effect when placed on the surgical area, thus, temporarily relieving you from the pain.
We recommend that you should apply ice packs to the surgery site for 20 minutes every four hours throughout your hospitalization. You shouldn't hesitate to ask your nursing staff for ice packs between various activities.
Cold therapy can also be very helpful after you are discharged from the hospital and are at home. If your legs feel heavy and stiff, you should rest in bed with ice packs applied to the tender or swollen areas. You could simply wrap ice cubes in a towel to make an ice pack for yourself.
For immediate relief from pain after surgery, you will be given pain killers by either injections or by Continuous Epidural infusion. With either method of pain medication, please do notify your nurse or doctor if you are not getting pain relief.
A day or two after your surgery, you will be switched to oral pain medication. This is because by this time, your surgical pain will be reduced and you will be able to progress with various activities more readily. Oral pain medication will help you resume daily activities with a minimum amount of discomfort. Our rehabilitation staff will assist you in a speedy recovery from your surgery.
If you need additional pain relief, your physiotherapist can provide you with Cryo cuffs or other cold therapy and introduce you to helpful relaxation exercises. Cold therapy in the form of ice packs or another cold therapy method will be provided as an intervention to reduce swelling and pain. This therapy produces an anesthetic effect when placed on the surgical area, thus, temporarily relieving you from the pain.
We recommend that you should apply ice packs to the surgery site for 20 minutes every four hours throughout your hospitalization. You shouldn't hesitate to ask your nursing staff for ice packs between various activities.
Cold therapy can also be very helpful after you are discharged from the hospital and are at home. If your legs feel heavy and stiff, you should rest in bed with ice packs applied to the tender or swollen areas. You could simply wrap ice cubes in a towel to make an ice pack for yourself.
Some guidelines to help you take care of the post surgery pain are.
1
Continue to apply ice packs to operation area for 20-minute intervals a few times a day. Especially after activity, cold therapy will continue to reduce post-operative swelling and provide you with greater comfort.
2
Take your pain medication as prescribed by your doctor. Remember to take it before the pain becomes too severe. It will help reduce the pain sooner.
3
In the event that the pain medication does not work, or you are experiencing unpleasant side effects, do not hesitate to call your orthopedic surgeon.
4
If you are taking medication, please avoid alcoholic beverages.
If you have questions, it is advisable for you to ask your physiotherapist before you leave the hospital. Your surgeon may also have additional instructions for you to follow upon discharge. Remember to record them as a reminder.
Post Surgery Exercise Regime
You should also practice relaxation exercises, such as slow rhythmic breathing, to handle any pain you may be feeling, as well as to provide overall comfort. Here's a quick guide to a breathing exercise:
1
Breathe in slowly and deeply.
2
As you breathe out slowly, feel yourself beginning to relax, feel the tension leaving your body.
3
Now breathe in and out slowly and regularly, at whatever rate is comfortable for you. You may wish to try abdominal breathing using your diaphragm. If you do not know how to do abdominal breathing, ask your nurse for assistance. This is facilitated by the rehab team.
4
To help you focus on your breathing, breathe slowly and rhythmically. Breathe in and say silently, 'in, two, three'; then breathe out and say silently to yourself, 'out, two, three.'
5
It may help you to imagine that you are doing this in a place that is very calming and relaxing for you, such as lying in the sun at the beach or in your own special place.
6
You may possibly relax by performing steps 1 through 4 only once. It may help to repeat steps 3 and 4 for up to 20 minutes.
7
End with a slow, deep breath. As you breathe out, say to yourself, 'I feel alert and relaxed.' Then, concentrate on staying that way.
Medications used to control pain are carefully prepared in order to assure quality and safety. At Fortis, we use bupivacaine and in certain cases, add fentanyl. Local anesthetic is a type of medication that is used to temporarily make a body part feel numb.
During your stay at the hospital, you must inform your anesthesiologist and peri-operative nurse about any problems that you may have encountered with medications of any type in the past. You must also inform them of any medications you are taking or have taken in the last 30 days, including over the counter (OTC) medications and herbal supplements or medications.
Soon after your surgery, you will be asked to perform some gentle exercises. These exercises will help prevent circulation problems and will also strengthen your muscles. You will be expected to perform these exercises ten times each, every hour while awake. Your physiotherapist will help you learn and perform these exercises. These exercises include quad sets, gluteal sets, and ankle pumps. Let's look at how these exercises are done.
To perform quad sets, tighten your thigh muscle and try to straighten your knee. Hold for 6 seconds and then relax. Repeat this exercise approximately 10 times during a two minute period, rest for one minute, and repeat. It is advisable to continue until your thigh feels fatigued.
To perform a gluteal set, lie on your back on a firm mattress and pinch your buttocks together. Now, hold for the count of 6 and relax. Continue these exercises periodically until full strength returns to your thigh.
To perform ankle pumps, move your foot up and down rhythmically by contracting the calf and shin muscles. Perform this exercise periodically for two to three minutes, two or three times an hour in the recovery room. You should continue this exercise until you are fully recovered and all ankle and lower-leg swelling has subsided.
In addition to these exercises, it is also important to exercise your lungs by taking deep breaths. You would normally take deep breaths each hour, usually without being aware of it. This is spontaneous, automatic, and occurs in the form of sighs and yawns.
However, when you are experiencing pain or drowsiness from the anesthesia or pain medication, your normal breathing pattern can change. In such cases, your physiotherapist will provide you a spirometer which will force you to take deep breaths. These are necessary to expand the small air sacs of your lungs and help clear the air passages of mucous. This helps avoid fever post-op. We recommend that you use your spirometer 10 times every hour while awake for the first several days after your surgery.
To achieve a slow Sustained Maximal Inspiration (SMI), inhale at a rate sufficient to raise only the ball in the first chamber, while the ball in the second chamber remains at rest. With the unit in an upright position, exhale normally; then place your lips tightly around the mouthpiece.
For a higher flow rate, inhale at a rate sufficient to raise the first and second balls, while the ball in the third chamber remains at rest. Now, exhale normally. After performing the exercise, remove the mouthpiece from your lips, exhale normally, and then relax.
Another excellent way to help breath and clear your lungs is coughing. It is one of nature's important methods for clearing your lungs at any time…not just after surgery. You can make a habit of doing this 2-3 times hourly, especially when it is inconvenient to use your spirometer. Here's how you can do it:
During your stay at the hospital, you must inform your anesthesiologist and peri-operative nurse about any problems that you may have encountered with medications of any type in the past. You must also inform them of any medications you are taking or have taken in the last 30 days, including over the counter (OTC) medications and herbal supplements or medications.
Soon after your surgery, you will be asked to perform some gentle exercises. These exercises will help prevent circulation problems and will also strengthen your muscles. You will be expected to perform these exercises ten times each, every hour while awake. Your physiotherapist will help you learn and perform these exercises. These exercises include quad sets, gluteal sets, and ankle pumps. Let's look at how these exercises are done.
To perform quad sets, tighten your thigh muscle and try to straighten your knee. Hold for 6 seconds and then relax. Repeat this exercise approximately 10 times during a two minute period, rest for one minute, and repeat. It is advisable to continue until your thigh feels fatigued.
To perform a gluteal set, lie on your back on a firm mattress and pinch your buttocks together. Now, hold for the count of 6 and relax. Continue these exercises periodically until full strength returns to your thigh.
To perform ankle pumps, move your foot up and down rhythmically by contracting the calf and shin muscles. Perform this exercise periodically for two to three minutes, two or three times an hour in the recovery room. You should continue this exercise until you are fully recovered and all ankle and lower-leg swelling has subsided.
In addition to these exercises, it is also important to exercise your lungs by taking deep breaths. You would normally take deep breaths each hour, usually without being aware of it. This is spontaneous, automatic, and occurs in the form of sighs and yawns.
However, when you are experiencing pain or drowsiness from the anesthesia or pain medication, your normal breathing pattern can change. In such cases, your physiotherapist will provide you a spirometer which will force you to take deep breaths. These are necessary to expand the small air sacs of your lungs and help clear the air passages of mucous. This helps avoid fever post-op. We recommend that you use your spirometer 10 times every hour while awake for the first several days after your surgery.
To achieve a slow Sustained Maximal Inspiration (SMI), inhale at a rate sufficient to raise only the ball in the first chamber, while the ball in the second chamber remains at rest. With the unit in an upright position, exhale normally; then place your lips tightly around the mouthpiece.
For a higher flow rate, inhale at a rate sufficient to raise the first and second balls, while the ball in the third chamber remains at rest. Now, exhale normally. After performing the exercise, remove the mouthpiece from your lips, exhale normally, and then relax.
Another excellent way to help breath and clear your lungs is coughing. It is one of nature's important methods for clearing your lungs at any time…not just after surgery. You can make a habit of doing this 2-3 times hourly, especially when it is inconvenient to use your spirometer. Here's how you can do it:
- Breathe in deeply through your nose.
- Hold your breath and count to 5.
- Breathe out slowly through your mouth
- ON the 5th deep breath, cough from your abdomen as you breathe out.
Blood clotting in the veins of the leg is another possible risk after a total joint replacement surgery. This is known as Phlebitis (inflammation of the veins of the legs) or Deep Vein Thrombosis (DVT). For the prevention of DVT after surgery, many patients will be prescribed an oral anticoagulant. The purpose of an oral anticoagulant is to prevent your blood from clotting.
The testing for DVT by the Doppler or Venogram tests will depend upon your surgeon's practice. The Ultrasound Doppler test is a non-invasive test for detecting Deep Vein Thrombosis. The test creates and measures sound waves generated by the moving blood cells. During this test, you will be asked to lie in the semi-upright position for the examination. There is no discomfort or special preparation for this test. The staff will discuss the results and any indicated treatment
The testing for DVT by the Doppler or Venogram tests will depend upon your surgeon's practice. The Ultrasound Doppler test is a non-invasive test for detecting Deep Vein Thrombosis. The test creates and measures sound waves generated by the moving blood cells. During this test, you will be asked to lie in the semi-upright position for the examination. There is no discomfort or special preparation for this test. The staff will discuss the results and any indicated treatment
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Dr. Kaushal Malhan
Dr. Sachin Bhonsle
Dr. Milind Sawant
