PITTSBURGH (KDKA) – For some people, hip or knee surgery are inevitable.
A local doctor is making the process a lot less painful using what you might call a special pain cocktail and his patients swear by it.
Eight years ago, Deborah Gossic had her left knee replaced. She had lots of pain for two weeks, took narcotics, couldn’t sleep and could hardly move.
“I was bone on bone eight years ago, and when I had the other one done, they said you’re going to need to get this one done, and I thought, ‘Okay, it’s going to be a long time before I go back and do this again.’ So, I’ve put it off for eight years,” Gossic said.
When sitting down, standing up, and going up and down stairs became more difficult, she knew it was time.
But to replace her right knee, a different doctor took a different approach to pain.
“Pain is one of the main reasons people don’t want to undergo surgery,”
“When I woke up from surgery, I said, I sort of moved a little bit and said, ‘Did you guys do anything?’ Gossic said. “I sat on the side of the bed, they stood me up, I walked across the floor, sat back down again, I had no pain. I was doing leg lifts. It took me weeks to do that the last time, and I was doing it the next day.”
Her orthopedic surgeon used what’s called a multimodal pain protocol, which uses a variety of drugs before, during, and after surgery to block pain all along its path – at the joint, spinal cord and in the brain.
This includes a nerve pain drug, Lyrica, and an anti-inflammatory medicine, Celebrex, prior to the operation.
As part of the surgery, the patient gets spinal anesthesia intravenous Tylenol, and special numbing injections all around the coverings of the bone.
“Same medication a dentist numbs a tooth up with, this is just suspended in a molecule of fat, and it is actually released over 72 hours, so people can have longer lasting pain relief without the need for a nerve block,” Dr. Brett Perricelli said.
Nerve blocks work well to block pain, but they also block signals to the muscles. As a result, patients can fall.
Narcotics also work to treat pain, but they can leave people feeling nauseous, constipated, and groggy, which is not a good combination for the best physical therapy.
The multimodal approach decreases the need for either of those.
In fact, Dr. Perricelli has had to limit some of his newly operated patients’ activities, because they’re bending their new knee so much right off the bat, they could pop their incisions which haven’t fully healed.
The knee numbing is designed to last 72 hours, but the effect can be even longer.
“ It did not hurt at all. I had no knee pain at all. I was waiting for it to wear off,” Gossic said.
“It’s the whole approach to it. It’s not just one thing that makes the difference. It’s encompassing oral medication, intravenous medication, injection into the knee, all rolled into one, which is giving us the best results,” Dr. Perricelli said.
If the results are so great, why aren’t all surgeons using this?
It’s still fairly new and only about a year’s worth of experience at some medical centers. Also, the price of $285 a vial could be an issue. It could cost a busy community hospital hundreds of thousands of dollars to acquire the injectable numbing medication for all its cases.
With variable insurance coverage, it can be an expense the hospital would just have to take on as part of the care bundle for a given surgery.
“There are charges associated with all the different drugs we’re using, and the injections we’re using. However, when patients are using less narcotics, when patients are having less side effects from narcotics, those charges are easily offset,” Dr. Perricelli said.
For Gossic, it was a worthwhile difference. Her surgery was three weeks ago and he still has not had any pain.