Taking a Shot at Pain Relief After Knee Replacement

By Amy Norton HealthDay Reporter

THURSDAY, Aug. 18, 2022 (HealthDay Information)

Researchers might have discovered a brand new means to assist ease the ache of knee substitute surgical procedure: infusing morphine instantly into the shin bone.

The findings come from a latest examine of 48 sufferers present process complete knee substitute. The investigators discovered that giving a morphine injection into the shin bone through the operation managed sufferers’ post-surgery ache higher than customary remedy alone.

It additionally lessened their reliance on probably addictive opioid ache medicines.

For now, the tactic is simply being finished at a restricted variety of medical facilities. So folks having their knees changed within the close to future are unlikely to have it as an choice.

However there is no such thing as a cause the method couldn’t be broadly adopted, in line with senior researcher Dr. Kwan “Kevin” Park, an orthopedic surgeon at Houston Methodist Hospital.

Whole knee substitute, which is often finished to deal with extreme arthritis, is a standard process, Park famous. A few many years in the past, sufferers would spend days within the hospital afterward, receiving high-dose opioids to regulate the ache.

Issues have modified since then, Park mentioned: Ache management has improved, with the assistance of medicines which are injected earlier than and through surgical procedure, for instance. And sufferers now are sometimes discharged on the identical day as surgical procedure.

However there’s nonetheless room for enchancment, he famous.

One purpose is to cut back the necessity for opioid painkillers, reminiscent of oxycodone and hydrocodone, within the days to weeks after surgical procedure. Moreover their addictive potential, the medicine can have unintended effects like nausea and constipation.

Opioids, Park mentioned, “nonetheless have a task. However we wish to reduce their use, and get sufferers off of them as quickly as doable.”

For the brand new examine, Park’s workforce used a way referred to as intraosseous infusion, during which treatment is instantly injected into bone marrow. The researchers had already studied the infusions as a option to ship antibiotics to the shin bone throughout complete knee substitute; the purpose there was to cut back the chance of an infection — a uncommon however severe complication, Park mentioned.

It labored. So the researchers wished to see whether or not including morphine to the infusion might assist management sufferers’ post-surgery ache.

Within the examine, 48 sufferers have been randomly assigned to one in every of two teams. In a single, sufferers obtained customary ache management and an antibiotic infusion into the shin bone; the opposite group was given the identical, however morphine was added to the bone infusion.

All the sufferers obtained basic anesthesia plus regional nerve blocks, which assist with post-surgery ache. They have been additionally prescribed painkillers to make use of after surgical procedure — both acetaminophen (Tylenol) for milder ache, or opioids for extra extreme ache.

On common, the examine discovered, sufferers given the morphine infusion reported much less ache within the two days after surgical procedure: Their ache scores on a regular scale have been 40% to 49% decrease — a distinction that waned a bit however endured by means of day 9. The sufferers additionally used fewer opioids within the two weeks after surgical procedure.

An orthopedic surgeon who was not concerned within the examine mentioned the outcomes sound “probably promising.”

“It is at all times thrilling to see new research popping out about controlling post-op ache after complete knee substitute,” mentioned Dr. Cynthia Kahlenberg, a hip and knee surgeon on the Hospital for Particular Surgical procedure in New York Metropolis.

Like Park, she mentioned that regardless of strides made in ache management, “many sufferers expertise extra ache than we might like after knee substitute surgical procedure.”

Kahlenberg mentioned bigger research are wanted to see if the present findings might be replicated. She additionally mentioned that many hospitals, together with her personal, have begun utilizing a further regional nerve block throughout surgical procedure — one which was not employed on this examine.

“I am unsure how a lot of a distinction this new method would make if the (researchers) have been incorporating each of the generally used regional anesthesia blocks fairly than only one,” Kahlenberg mentioned.

Park mentioned additional research are deliberate.

For now, it is not fully clear why a single bone infusion of morphine, which has fast however momentary results, helps management post-surgery ache for days. However Park mentioned his workforce believes the blunting of the preliminary ache is vital.


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The examine was lately printed in The Journal of Arthroplasty.

Extra info

The American Academy of Orthopaedic Surgeons has extra on complete knee substitute.

SOURCES: Kwan “Kevin” Park, MD, orthopedic surgeon, Houston Methodist Hospital, Houston; Cynthia Kahlenberg, MD, MPH, hip and knee surgeon, Hospital for Particular Surgical procedure, New York Metropolis; The Journal of Arthroplasty, June 2022


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