Managing pain at home

August 27, 2009 3:33:56 PM PDT
Total joint replacements often mean months of recovery starting with several days in the hospital and receiving powerful pain medications. Now, surgeons say there's no need for most people to spend so much time in the hospital or take narcotics. Doctors are putting the power of pain management in the patients' hands.Chuck Short rarely misses his mark, but a shoulder injury threatened to throw him off target. He originally dislocated the joint during his days as a high school pole-vaulter. Three decades later, it was time for a total shoulder replacement.

"I just kept slamming that shoulder," Short said.

Typically, the surgery puts patients in the hospital for three to five days. Short was on his way home about two hours after the operation.

"I was really amazed that he said that I was going to be home the same day," Short said.

Before surgery, Short was fitted with a home pain catheter. Doctors insert a tiny plastic tube near the nerves that feed the shoulder. It's connected to a pump that holds a safe amount of novocaine.

"They can dial back the local anesthetic," said Dr. Randall Malchow, director of the Regional Anesthesia and Acute Pain Fellowship at Vanderbilt University Medical Center in Nashville, Tennessee. "If they're not numb, they can go ahead and increase the rate on the pump so it infuses a continuous novocaine, a long-acting novocaine, through the pain catheter."

"It's just like going to the dentist," Short said. "You're totally numb."

Patients wear the pump for three days, then pull it out themselves and continue pain meds.

"We feel if we can aggressively treat their pain for the first 72 hours or so that the pain diminishes every day thereafter," Dr. Malchow said.

Doctors say it reduces the need for narcotics and cuts a hospital bill by as much as $10,000.

"It's much, much better than staying in the hospital," Short said.

Short even found a way to get back to the range sooner.

"I kind of taught myself how to shoot left-handed," he said.

Doctors say the pump holds exactly the right amount of novocaine to prevent overdose. The home pain catheter can be used for shoulder, elbow, wrist, knee and hip replacements. Dr. Malchow says there is about a 1 percent chance the pain medication doesn't reach the right nerves and the patient has to be re-admitted to the hospital.


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