Knee Replacement: Targeted Pain Control is Key to Recovery

Of the more than 600,000 knee replacements done in the U.S. each year, the number of people in their 50s and even 40s having the procedure is growing. While carrying excess weight is one factor — one pound of excess weight is equal to five pounds of pressure on joints — middle-aged people are increasingly electing to have knee replacements to stay active and improve their quality of life.

MD PatientTo gain the full benefits of knee replacement, one of the most important aspects is rehabilitation. Specialized techniques using targeted pain relief help jump start rehabilitation, which can decrease time in the hospital and more quickly establish a new joint’s range of motion.

Reducing pain while sparing strength

In a study led by Virginia Mason anesthesiologist Neil Hanson, MD, physicians found that total knee replacement patients did better when local anesthetic medications were continuously infused into the adductor canal, a tunnel in the mid-thigh that contains the femoral artery, femoral vein and nerve branches. This continuous nerve block technique not only reduces pain, but allows patients to maintain muscle strength in the leg, which is critical to recovery.

“We found that by infusing the local anesthetic medication in a location that preferentially blocked sensation to the knee, we reduced muscle weakness, controlled pain more effectively and made a shorter hospital stay possible,” said anesthesiologist David Auyong, MD.

As participants in regular clinical research, the Anesthesiology and Orthopedics and Sports Medicine departments at Virginia Mason became early adopters of the adductor canal block approach, making it the gold standard for most total knee replacements performed at the medical center.

The benefits of continuous pain relief

Adductor canal block is an improvement over previous blocking techniques because it provides pain relief without causing weakness. Femoral blocks were used in the past, which provided good pain relief but reduced muscle strength. They also put patients at risk for falls.

Adductor canal block, along with different types of anesthesia, helps accelerate recovery with a quicker return to full motion and function. The approach uses an “indwelling” catheter, providing up to three days of continuous post-surgical pain relief. It can also  reduce the amount of pain medication that a knee replacement patient might need, which in turn lowers the risk of medication side effects.

Other benefits of early mobilization after knee replacement include a lower risk of blood clots, stiffness and other complications that can occur from long periods of inactivity.

Board-certified orthopedic surgeons at Virginia Mason perform nearly 1,000 joint surgeries annually. Please visit our joint replacement page and knee replacement page, or call
(206) 341-3000.   


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