Total knee recovery is getting much better these days. When I make rounds now the day after surgery, there are a lot more smiling faces. In the “old days”, the knees were very painful for a few days. Now we use new pain management techniques that minimize the pain without narcotics. We try to avoid general anesthetics that can lead to confusion and nausea post operatively.
First off, the spinal anesthesia allows a very gradual transmission of the pain to the brain- making it much more tolerable. We have the capacity to release our own narcotics ( endorphins) in response to stress, and the spinal makes this a better, more gradual process. Next, we use a femoral nerve block. Our specialist anesthesiologists are beginning to isolate the sensory component of the femoral nerve ( the saphenous branch), so that the pain is gone for 36+ hours, but the motor function stays intact. This will allow earlier and eventually same day discharge for motivated patients. We are also now using Exparel*, a timed release local anesthetic that can last up to 72 hours. By avoiding narcotics, patients are less nauseas, and are able to be more active. Toradol is a potent pain med that is not a narcotic, and we can inject this into the IV every 6-8 hours. Patients really are doing better, with a lot less pain.
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