A group of physicians in Frederick, Md., completed their first total knee replacement surgery without narcotics, Frederick News Post reports.
Here are seven insights.
1. The procedure was performed March 27 at Frederick Surgical Center.
2. The medical team included Eric Shepard, MD, the director of anesthesia for Frederick Surgical Center, and Robert Fisher, MD, an orthopedic surgeon at Monocacy Health Partners in Frederick.
3. Post-operative pain management commonly involves the use of opioids. In 2014, opioids were prescribed to one in 12 hip and knee replacement patients.
4. Dr. Shepard and Dr. Fisher said not every patient could recover without the use of narcotics.
"We never want to give the impression that a patient can go through a knee surgery and not need a single opioid," Dr. Shepard told Frederick News. "But up until recently, they were really the only drug considered a mainstay of postoperative care. That's something we're trying to move away from."
5. Before the operation, Dr. Shepard injected the patient with a long-acting dose of the nerve blocker Exparel. He also injected this drug into the knee's soft tissue after inserting the implant device, before closing the wound.
A different type of nerve blocker was inserted into the patient's thigh after the incision was closed. This nerve blocking agent was connected to a catheter with a self-operating pump. The patient could squeeze the pump and release the medication to manage pain for three days after the surgery.
6. The physicians do prescribe opioids after surgery, but this particular patient did not take any. He recovered fast enough to drive himself to his first outpatient physical therapy appointment at the beginning of April.
7. John Baker, a physical therapist and the owner of Frederick-based Baker Rehab Group, is working with local surgery centers to implement the "physical therapist as navigator" model of patient care, which can improve patient outcomes and help reduce opioid use.
Following this model, physical therapists meet with patients a month prior to surgery and conduct a home safety assessment to determine whether they're good candidates for outpatient surgery. The physical therapists also coordinate with the surgeon and anesthesiologists to determine treatment plans.