Pain Management for Hip Replacement Patients
|Linda Badgley welcomes spring by planting flowers in her garden. It's one of many activities she's able to enjoy again after hip replacement surgery.
There’s a new doctor in town, and he’s quickly gaining recognition as a “champion of pain management” by peers and patients alike.
When Ryan Bauman, MD, joined the Orthopedic Institute of Dayton in August 2010, he brought with him some new ideas about pain management, especially within his area of expertise, total joint replacement.
Dr. Bauman was eager to promote the surgical procedures and pain management techniques he had learned during his orthopedic residency at the Mayo Clinic and his post-residency fellowship at the Colorado Joint Replacement Center.
He was just the kind of specialist Linda Badgley was looking for when she called the Orthopedic Institute of Dayton in September 2010 seeking relief for debilitating pain in her right hip.
Five Years of Pain
Linda’s pain in her hip and leg had begun in 2006. Having turned 50, she chalked it up to “old age” and “genetics,” recalling her mother and other relatives had experienced joint pain. Her doctor diagnosed the onset of osteoarthritis and prescribed calcium, Vitamin D and exercise.
Over the next several years, the pain would come and go. But in April 2010, she experienced “excruciating” pain in her thigh. Thinking she had pulled a muscle in her groin, Linda saw her doctor. She ordered x-rays, which indicated her arthritis had progressed.
“My doctor told me I was too young to consider surgery and prescribed over-the-counter pain killers,” recalls Linda.
When the pain persisted, Linda saw a chiropractor, receiving some temporary relief. But, that fall, when she returned to teaching, she was limping and by her own account “barely mobile.” A teacher friend convinced her to consult an orthopedic specialist and recommended the Orthopedic Institute of Dayton.
That’s when Linda connected with Dr. Bauman.
A Different Approach
|Ryan Bauman, MD
“From my first office visit with Dr. Bauman, I felt someone was really listening to me and understood my pain and frustration,” says Linda.
Dr. Bauman ordered a new series of x-rays and then scheduled another meeting with her and husband David to review the results. The x-rays showed Linda’s hip had completely deteriorated. “There was no cartilage – it was almost bone-on-bone,” says Linda.
“I now understood the reason I’d been in so much pain,” she says. “My husband and I were both impressed with Dr. Bauman’s professionalism. He spent a lot of time with us and explained everything in detail. Consequently, I was eager to have the hip replacement Dr. Bauman recommended. I was eager to be pain-free.”
Not only was Linda going to be pain-free after she received a new hip, she was going to have less post-surgery pain, thanks to a new protocol that Dr. Bauman has introduced at MVH.
Blocking Pain Along Multiple Pathways
A basic tenet of Dr. Bauman’s aggressive pain management protocol is managing pain prior to surgery. To begin with, Dr. Bauman’s patients take anti-inflammation oral medication several hours before surgery. (Inflammation is a major cause of post-surgery pain.)
Then, just before surgery, Dr. Bauman or an anesthesiologist gives patients a fascia iliaca compartment block (FICB), a regional anesthesia that blocks nerves in the groin, thigh and hip. The block is effective for 16 to 24 hours after surgery.
With FICB, the needle does not come close to the femoral artery and nerves. Thus, it is considered safer than other regional blocks.
At MVH, Dr. Bauman has been an outspoken advocate of FICB, convincing surgeons to use it and anesthesiologists to administer it. “They readily see the advantages of FICB and have embraced it with enthusiasm,” reports Dr. Bauman.
During surgery, Dr. Bauman’s patients receive a spinal block, which prevents the passage of nerve impulses in the spinal cord so they have no feeling from the waist down; they are also sedated so they are unaware of the surgery, which typically lasts two hours.
Before the effects of the anesthesia wear off, most patients receive low doses of narcotics so the meds are “on board” as the numbness fades. Non-narcotic pain medications (such as Tylenol and Motrin) and muscle relaxants are also prescribed.
Dr. Bauman says this comprehensive pain control plan results in significant benefits for his hip replacement patients, including:
- A shorter hospital stay – two nights instead of the usual three
- The need for fewer narcotics after surgery
- Fewer, if any, of the side effects caused by high doses of narcotics, such as confusion, constipation and prolonged post-operative sedation
- A reduced risk of chronic pain, which can develop when acute, post-operative pain is not treated aggressively
At MVH, the surgeon, the anesthesiologist, nurses and therapists work together to create what Dr. Bauman calls a “circle of care” so hip replacement patients have a good overall outcome, including less pain.
From the Patient’s Perspective
Linda can attest to that circle of care.
“I entered the hospital on Tuesday and left on Thursday,” reports Linda. “The day after surgery, I was on my feet and walking.”
When she returned home, she used a walker for two weeks, relying on it less each day. She says her pre-operative training and in-hospital therapy prepared her to perform everyday moves such as getting in and out of bed and the shower.
She experienced moderate post surgery pain and took low doses of narcotics for a short time. “When one of my friends noticed the dosage on my medication, she was astonished that I wasn’t on anything stronger,” notes Linda. (While she was in the hospital, her pain level was 4 or below on a numeric pain scale of 0 to 10.)
Linda was good to return to work within six weeks – although the Christmas school break extended her time off to eight weeks. After the holidays, she returned to her second grade classroom, rested, energized – and pain-free.
Fast-forward to spring break in late March: Linda and David spent a week in Arizona hiking the rim of the Grand Canyon and climbing Cathedral Rock in Sedona.
This spring, Linda is looking forward to hiking in Sugarcreek Reserve with David and planting her summer garden. She’s planning to spend much of the summer at the family’s vacation home on Cumberland Lake in Kentucky, where she loves to boat and swim.
After 34 years in the teaching profession, Linda is eyeing retirement. “I want to be healthy when I retire. That’s one reason I wanted to have hip replacement surgery now,” explains Linda.
“I would urge others in my situation to do the same,” she says, “regardless of their age.”