PAIN RELIEF TO GO AFTER SURGERY
At most hospitals across the country, patients who undergo orthopedic surgery are given narcotics to help them handle the pain. Narcotics have a lot of side effects, and many patients simply aren't able to take them. Now, technology is offering a new kind of pain relief.
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Rob Michel's love for Harleys started young.
Rob Michel
"I knew then I was born to cruise. I just love getting on the road and going."
But an accident at age 14 nearly killed him.
Rob Michel
"I was riding my dad's Harley on the back. It was almost a whole year before I walked again."
His badly broken leg led to a lifetime of injuries. He finally had reconstructive knee surgery as an adult. The pain was awful, but the narcotics made him sick.
Rob Michel
Suffered pain
"I just gave up the medicine after a few days and just took the pain."
When Rob hurt his other knee while skiing, he couldn't bear the pain of getting it fixed again. Then, Doctor Jeff Swenson offered him a new pain relief option.
Right before or after surgery, doctors use ultrasound images to safely and precisely thread a needle close to a nerve -- without touching it. The nerve is then soaked with an anesthetic.
A catheter and balloon pump pain relief to the nerve for two days as the patient recovers at home.
Jeff Swenson, MD
Anesthesiologist
University of Utah Orthopaedic Center
Salt Lake City, UT
"The placement of nerve blocks with ultrasound guidance is going to be one of the most significant revolutions in anesthesia that has occurred in the last 20 or 30 years."
Rob had the procedure when he had his surgery last year.
Rob Michel
"100 percent better. I mean, it was just, I wouldn't be afraid of going back in for another surgery."
But he's not planning on it. He's back on the road and hopes he's left his injuries in the dust.
Once the pain medication is used up, patients can simply throw the catheter away. Doctor Swenson says this technology is best for orthopedic procedures like shoulder surgeries, knee surgery and foot and ankle procedures.
BACKGROUND: According to the National Center for Health Statistics, when it comes to our body, we know when it hurts:
About 31 million visits were made to physicians' offices due to back problems in 2003.
About 19 million visits were made due to knee problems in 2003.
Nearly 14 million visits were made due to shoulder problems in 2003.
About 11 million visits were made to due to foot, toe, and ankle problems in 2003.
Broken legs, shoulder tears, torn knee cartilage, fractures...the list goes on. As bad as all those injuries are, getting them fixed can be just as painful -- sometimes more painful. Narcotics are often used to control that pain, but they can have a lot of unwanted side effects like nausea, vomiting, itching, sedation and constipation.
PUTTING AN END TO THE PAIN: Catheters and nerve blocks have been used to control pain following orthopedic surgery like knee replacement and ACL repair. However, to get the catheter in the right spot, anesthesiologists have had to either illicit an electrical response from the nerve with a nerve stimulator, which is uncomfortable for the patient or actually touch the nerve, which is painful and can cause nerve damage. Now, doctors are using ultrasound guidance to deliver easier and more accurate pain relief before the patient undergoes surgery. Jeff Swenson, M.D., from the University of Utah, says: "With ultrasound guidance, now we can look on the screen, place the needle close to, but not touching, the nerve and watch the local anesthetic surround the nerve without ever causing any pain. That's going to revolutionize safety and speed of placement for these nerve blocks."
HOW IT WORKS: Before the scheduled surgery, doctors locate the nerve with ultrasound, thread a needle and catheter to the spot, and deliver the anesthetic. They use a low-dose and a low volume of a local anesthetic called bupivacaine. Then, they attach the catheter to a bottle that contains a balloon filled with bupivacaine. The bottle is wrapped in an elastic bandage around the leg. The patient has this attached before the surgery and the balloon continuously delivers the anesthetic to the targeted nerve for two days following the surgery. When the medication runs out, patients simply take it off and throw it away. Dr. Swenson says: "If we can give [patients] some type of modality that relieves their pain and allows them to go home and be recuperating at home, most patients will jump at the chance to do that. It's really an amazing technology that we can use ultrasound to safely place those catheters very rapidly with minimal discomfort to the patient." The best part about this, he says, is that patients usually don't need heavy narcotics to control their pain because the anesthetic delivered through the catheter is enough.
The main types of surgery that this is currently used for include rotator cuff repairs in the shoulder, shoulder dislocation repairs, anterior cruciate ligament (ACL) reconstructions in the knee, and major foot and ankle procedures. Dr. Swenson says if you're having orthopedic surgery, talk to different hospitals about what kind of pain relief you'll receive. He says: "Most academic centers of anesthesia -- probably 50 percent -- have already adopted this technology. A much smaller percentage of those are very adept at this new technology."
Jeff Swenson, M.D.
University of Utah Orthopaedic Center
590 Wakara Way
Salt Lake City, UT 84108
(801) 587-7100
http://uuhsc.utah.edu
Copyright © 2006 Ivanhoe Broadcast News, Inc.
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