Having any major operation results in some pain which if not controlled, can hamper your recovery. The care pathway here at the centre combines pain management before, during and after surgery, with a shift from general to local anaesthesia. Evidence shows that this the best option for most patients, resulting in significant reduction and better control of pain. However, everyone experiences pain differently (sometimes known as a ‘pain threshold’) so our team will ensure that your pain relief is adjusted to your specific needs.
The benefits of having good pain relief include:
Your surgery will, most likely, have been performed under a regional anaesthetic. The effects of the anaesthetic will last up to 3 hours after your surgery has been completed. Once the effects have worn off, the mainstay of your pain relief will be in the form of oral medication.
Your nurse will regularly ask you how you’re feeling and how much pain you are experiencing. They may ask you to ‘score’ your experience of pain on a scale of 0-10, where zero is no pain and 10 the most severe.
If you experience pain during physiotherapy/exercise sessions, tell your physiotherapist so that you can have appropriate pain relief. It’s important that pain does not hold you back from doing exercises designed to help your recovery/ mobility.
The pain relief programme at the Fortius Joint Replacement Centre is based on the World Health Organisation’s pain ladder and is designed to minimise pain and side effects whilst best maintaining your ability to recover and rehabilitate. The general principle is to start with first step drugs, and then to climb the ladder if pain is still present. The medications range from common, over-the-counter drugs at the lowest rung, to strong opioids. Your personalised pain regimen will consist of all or some of the following medication.
Anti inflammatory drugs can cause gastric irritation so you will be asked to take regular medication to protect your stomach lining. Opioid pain relief medication can cause side-effects including nausea, vomiting and constipation. You will be taking regular medication to maintain bowel function and additional medication is available to counter the other effects.
All surgery carries some risks. In most cases, complications can be prevented or easily treated by taking the right precautions and prompt action when necessary. However, it’s important to discuss any likely complications with your surgeon and anaesthetist before your procedure, especially if you have a pre-existing existing medical condition such as high blood pressure or diabetes. You’ll be asked to sign a form consenting to your surgery before the procedure.
Modern drugs, equipment and training have made anaesthesia – a much safer procedure. Researchers are continuing to investigate new methods of pain management including different drug combinations and delivery methods. While serious reactions to anaesthesia are uncommon, you may still experience some side effects and all anaesthetic procedures carry a degree of risk.
At the Fortius Joint Replacement Centre we aim to provide our patients with the safest treatment pathway that not only speeds up your recovery, but also keeps pain and the risks associated with anaesthesia to a minimum.
Before your surgery you’ll have an opportunity to meet the anaesthetist who will be managing your pain relief and wellbeing during your operation. You’ll have an opportunity to discuss the various options, including the advantages and disadvantages of each and any risks involved.
Most patients choose to have regional anaesthesia and this is the method most often advised. However, it’s important to know that this may not be the right option for you.
For knee replacement surgery most anaesthetists will also perform an adductor canal block and details of this technique are given below:
This means you will be numb from the waist down (the ‘region’ anaesthetised) and feel no pain during the operation. You can also be asleep if you wish. It is different from a ‘general’ anaesthetic where you are unconscious with a breathing tube in your throat. The main type of regional anaesthesia offered is a spinal anaesthetic.
Local anaesthetic is injected near to the nerves in your lower back.
Because of the advantages a spinal anaesthetic gives you, we recommend this type of anaesthesia for your operation.
Occasionally, patients are offered an epidural in combination with a spinal or a general anaesthetic.
A small plastic tube (an epidural catheter) is passed through a needle into a place near to the nerves in your back. You receive local anaesthetics and pain relief drugs through this tube, relieving pain and reducing all feeling in your lower body.
Although operations can be done with an epidural alone, it is more commonly used for those operations that:
General anaesthesia is often used for major surgery, including joint replacement. However, unlike regional anaesthesia, it affects your whole body and means you are temporarily unconscious, during which time you will not be able to feel anything.
Disadvantages and side-effects
Patients having knee replacement surgery may also have an Adductor Canal Block. The adductor canal is an anatomical structure half way up the thigh that contains the saphenous nerve as well as the artery and vein. The saphenous nerve supplies sensation to a significant proportion of the knee and so depositing local anaesthetic around this nerve will improve your pain relief after the operation. Also, significantly, this technique does not impact upon the muscles ability to function which will enable you to be able to do your physiotherapy on the day of your procedure.
The local anaesthetic is deposited in the form of an ultrasound guided injection. This is done once your regional anaesthetic is working or, if you are having a general anaesthetic, once you are asleep.
The risks and potential side effects are minimal and it has been shown to be a safe and effective additional pain relieving technique.