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 What began with the pursuit of effective
pain relief for joint replacement patients took
anesthesiologist Joseph Marino, MD, across the
country and onto the printed page. Dr. Marino
was among the pioneers of using peripheral nerve
blocks rather than narcotic pain relievers in
joint replacement patients during the postoperative
period. He found the benefits to be multiple -
not only did patients experience a significantly
greater degree of pain relief, but they did so
without the side effects that commonly accompany
narcotic pain remedies - confusion, grogginess,
nausea, and respiratory depression.
"I knew that this was working for
our patients, but there was a lack of empirical
data published about the benefits of nerve blocks,"
Dr. Marino recalled. So he set out to perform
his own study.
Three years later, after enrolling
225 patients in a randomized clinical trial comparing
peripheral nerve blocks to patient controlled
analgesia (PCA) in postoperative hip replacement
patients, Dr. Marino has written two textbook
chapters about this highly specialized procedure,
presented a number of lectures to his colleagues
around the region, spoken at the national Anesthesiology
Society meeting held in San Francisco, and submitted
his research findings to a major medical journal
for publication.
This caliber of academic activity
is more commonly associated with physician-scientists
at large, academic medical centers. Dr. Marino
and the Department of Anesthesiology at Huntington
have created a model for establishing a postoperative
pain service at hospitals around the country.
"Ten years ago, patient controlled
analgesia was the standard of care for patients
undergoing joint replacement surgery," Dr. Marino
pointed out. These patients typically received
a narcotic such as morphine infused through a
pump. A button on the pump enables patients to
administer the medication when dictated by their
own pain level.
"Narcotic pain medicines are fraught
with side effects, and the people most sensitive
to these side effects, particularly confusion
and respiratory depression, are the elderly,"
Dr. Marino said. "With the use of continuous peripheral
nerve blocks as an alternative, many patients
manage to receive no narcotics at all."
Others may receive a prescription
for an oral narcotic medication when they leave
the hospital. "The most painful post operative
period is the first 72 hours after surgery, so
the nerve block is continued for that period of
time," Dr. Marino explained. "By the time patients
are ready to leave the hospital the majority of
their pain symptoms will have dissipated."
Debbie Patane knows
first-hand how well the nerve blocks work. Three
years ago, the 41-year-old mother of two underwent
her first total hip replacement surgery. Mrs.
Patane, a registered nurse who is married to a
general surgeon, was given PCA in the form of
a morphine pump following her surgery.
"The first night I was in tremendous
pain and the PCA did not do much for me," she
recalled.
Two years later, osteoarthritis forced
her to return to her surgeons, David Weissberg,
MD and Scott Alpert, MD, for her second total
hip procedure. This time, she was given a nerve
block while still in the recovery room.
"The difference was like night and
day," Mrs. Patane said. "I was able to rest that
first night, and get up and move around the next
day."
"Joint replacement patients need
to get up to begin therapy right away," Dr. Marino
noted. Continuous peripheral nerve block techniques
allow patients to participate in an accelerated
physical therapy program which improves outcomes
and reduces the duration of their hospital stay.
Patients are examined daily by members of the
Department of Anesthesiology to ensure adequate
pain control as well as monitor for any block-related
side effects such as numbness.
According to Dr. Marino, peripheral
nerve blocks are superior to epidurals because
they target one specific area without numbing
the entire lower half of the body, allowing patients
to get out of bed and walk shortly after surgery.
However, placing peripheral nerve blocks is technically
demanding and requires special training.
"For this reason, we are still one
of only a handful of hospitals to offer this type
of pain relief," Dr. Marino concluded. "Patients
undergoing total joint replacements at other hospitals
may not be given this option."
The Department of Anesthesiology is
an integral part of Huntingon's Center for Orthopedics
and Joint Replacement's commitment to providing
patients with a safe and painless total joint
replacement surgery experience. |
