2 Approaches for Treating Preop, Postop Orthopedic Pain
At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, Tim Lubenow, MD, professor of anesthesiology, anesthesiologist and pain physician at Rush University Medical Center and Rush SurgiCenter in Chicago, presented techniques for treating patients with preoperative or postoperative orthopedic pain.
Dr. Lubenow began by discussing a hypothetical patient case in the pain center arena, one he termed a clinical conundrum:
- The patient is suffering from persistent pain and decreased range of motion following a previous knee procedure.
- The patient has been on opiates for a long time — many months to years.
- The patient may need pathology requiring additional surgery.
- The patient may also still have symptoms of edema, allodynia and discoloration.
Dr. Lubenow then asked the audience what they would do. "This is admittedly a difficult patient. Are treatments of conservative care, oral medications and physical therapy the answer? Or, would you refer the patient to pain physicians for injections and a potentially limited response?" he asked.
Dr. Lubenow went on to explain that the problems with the patient in the clinical conundrum could occur with a couple different types of patients. "Whether the patient is still in the hospital or in the early stages of their post-operative timeline, there is often inadequate pain control. This sets the patient into a downward spiral of failure," said Dr. Lubenow. When there is post-operative pain, the following problems can follow:
- Failure to progress in physical therapy;
- Decreased range of motion;
- Persistence of postop edema, which leads to more pain.
- More decreased range of motion and stiffness.
According to Dr. Lubenow, an adequate analgesia is important to recovery from these types of negative outcomes. "The intensity of preoperative pain is directly correlated with the amount of morphine needed for post-operative analgesia. Typically, patients with severe preoperative pain consume less than 50 percent of morphine postoperatively compared to patients with mild or moderate preoperative pain," said Dr. Lubenow.
In order to control for post-operative pain, Dr. Lubenow recommends clonidine. The difference in pain preoperatively and postoperatively is one of the reasons Dr. Lubenow began using clonidine to treat pain for patients. "Patients with postop analgesia and/or with chronic preoperative opioid consumption see improvements almost four hours after administering clonidine," said Dr. Lubenow. In addition, epidural infusions also help cut postop pain for patients, especially those with "difficult orthopedic pain," said Dr. Lubenow.
Continuous epidural infusions
To close, Dr. Lubenow covered the advantages of continuous epidural infusions as a method for treating patients suffering from orthopedic pain:
- Well established in anesthesiology practice
- Offers flexibility to use different medications
- Allows for optimal pain relief
More Articles on Pain Management:
4 Thoughts on the Current Pain Management Environment
Pain Specialist Joins Boca Pain Management
American Pain Society Names Rober Fillingim President
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