Welcome to our information page on Total Knee Replacements!
We work closely with your orthopedic surgeon to provide the best care and best pain control regimen during and after your surgery with our Enhanced Recovery After Surgery (ERAS) protocol.
What is Enhanced Recovery After Surgery? |
In cooperation with ProHealth and Orthopeadic Associates of Wisconsin, we at ANEX, S.C. have developed a protocol for the Enhanced Recovery After Surgery (ERAS) to safely and efficiency guide patients through their total knee replacement surgery. Total knee replacement surgery is well-known to be painful, which can limit rehabilitation and function of the new joint and increase hospital stays. The protocol developed uses multiple ways to target pain (known as multi-modal analgesia) to limit the amount of pain experienced (although it will still hurt), maximize physical therapy sessions, and allow for discharge from the hospital within one to two days. This includes using medications that act differently yet synergistically as well as regional anesthesia (nerve blocks). All of these techniques act to limit the amount of opioid (narcotic) medications you need to take and their side effects (sleepiness, nausea and respiratory complications).
|
What happens before surgery? |
Your surgeon will prescribe different medications for you to take two days prior to your surgery. Then, when admitted to Day Surgery, you will be given these and other medications to ensure adequate levels in your system when you have your procedure.
After getting ready for surgery in the Day Surgery area, you will be transferred to the recovery area to have another key component of the ERAS protocol, the adductor canal block. This peripheral nerve block targets the sensory fibers of the front part of the knee, where the majority of pain from this operation resides while allowing for adequate strength in the quadriceps (the main muscle group in the front of the upper leg), so that physical therapy is not interrupted. |
What is a continuous adductor canal nerve block? |
The adductor canal nerve block is performed to inject local anesthetic medication, or numbing medication, around the femoral nerve. If you are a candidate for a continuous block, a small flexible catheter is placed to continually infuse local anesthetic medication to assist with pain control for up to 72 hours after surgery. It will remain in place even after you go home, and you will be able to simply and painlessly remove the catheter yourself when the medication infusion is complete. For more information on this, including the risks involved, please click here.
|
What happens in the operating room? |
Your anesthesiologist will devise a plan for anesthesia that is tailored to your personal health while ensuring your safety in the operating room. Patients can receive spinal anesthesia for the safest and best practice with sedation or general anesthesia for complete comfort while in the operating room. For more information on the different types of anesthesia please see our Patient Information page.
In addition to your pre-operative pain medications and adductor canal nerve block, you will also likely receive pain medications through an IV and your surgeon may opt to perform a posterior capsular injection to help with pain control on the posterior, or back, part of your knee. This injection contains similar numbing medication used in the adductor canal nerve block, which again covers pain over the anterior, or front, part of your knee. |
How is my pain managed after surgery? |
With the ERAS protocol, your pain will continue to be controlled after surgery by the adductor canal nerve block as well as with multi-modal pain medications which may include medications such as gabapentin, Tylenol, NSAIDS, and opioids. If you have a continuous nerve block catheter, the medicine will fill a ball-shaped pain pump, called an On-Q pump, that can be left in place for up to 72 hours. Patients can be discharged from the hospital with this pump for continued pain relief while at home and throughout rehab. The entire system is disposable and the catheter can be removed and disposed of at home.
For more information regarding management of the On-Q pump, including instructions on how to remove the catheter at home, please see our Adductor Canal Nerve Block page. |