Anesthesia and Pain Control at UMass Memorial Medical Center October 2014

1. NS ANES 0025 Rev 09/22/14
UMassMemorial
Medical Center
A Member of UMass Memorial Health Care
Patients and families trust UMass Memorial Medical Center as
the region’s leading academic medical center, committed to
improving the health of our communities in Central New England.
With our partner, the University of Massachusetts Medical School,
we are committed to excellence in care, community service,
teaching and research. The Medical Center offers advanced
technology and support services for patients and families,
providing the region with specialists renowned for their expertise
in caring for adults and children.
Contributions to UMass Memorial Medical Center are deeply
appreciated. Call 508-856-5520 or email giving@umassmed.edu.
UMassMemorial
Health Care
UMass Memorial Health Care is the largest not-for-profit health
care system in Central New England with more than 13,000
employees and nearly 2,000 physicians, many of whom are
members of UMass Memorial Medical Group. Our member
hospitals and entities include Clinton Hospital, HealthAlliance
Hospital, Marlborough Hospital, UMass Memorial Medical Center
and Community Healthlink, our behavioral health agency. With
our teaching and research partner, the University of Massachusetts
Medical School, our extensive primary care network and our
Cancer, Diabetes, Heart and Vascular, and Musculoskeletal Centers
of Excellence we deliver seamless programs of quality and
compassionate care for patients across our health care system.
Follow umassmemorial on:
Department of Orthopedics and Physical Rehabilitation
Division of Arthritis and Joint Replacement Surgery
UMass Memorial Medical Center – University Campus
55 Lake Avenue North, Worcester, MA 01655
www.umassmemorial.org/ortho
Anesthesia
and Pain
Control for
Total Joint
Replacements
Anesthesia and Pain Control_Your Guide to OH Surgery 10/2/14 4:09 PM Page 1

2. Anesthesia and Pain Control_Your Guide to OH Surgery 10/2/14 4:09 PM Page 3
2 7
About This Booklet
The information provided in this booklet is intended to be your guide as you plan for your
upcoming total joint replacement surgery. This guide was written by your Arthritis and Joint
Replacement Center care team at UMass Memorial Medical Center in order to help answer
many of the questions you may have regarding your surgery and recovery. We hope you find
the information in this booklet helpful. We also encourage you to speak with your doctor or
member of your health care team if you have any additional questions.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. 0 1 2 3 4 5 6 7 8 9 10
How often will I be able to get pain medication?
Answer: You’ll receive long acting pain medications twice a day, such as gabapentin and
Celebrex. You may receive an opioid, Tylenol, or a combination of the two for pain every
few hours. You’ll also have your backup intravenous and oral opioid medication, should you
need it. Please tell a member of your care team about your level of pain so they can better
treat it. They’ll show you a pain score chart to help you describe your pain (zero is no pain,
ten is extreme pain).
If I have a high pain score, will I always get pain medication?
Answer: Usually, but not always. Depending on the side effects of medications (sleepiness,
change in mental status, difficulty breathing, etc.), it may be safer to wait. Opioid
medications sometimes cause these side effects, but for at least 24 hours you’ll be closely
monitored to ensure there are no severe side effects from medications.
If you were on pain medications prior to your surgery, it might take longer to find the
correct dose after your surgery because your body is tolerant to the medications.
What about the nerve block I had earlier?
Answer: The nerve block will begin to wear off after 12 to 16 hours. As soon as it starts to
wear off, let a member of your care team know so that additional pain medications can be
provided.
What type of pain medication will I have when I leave the hospital?
Answer: Most likely you’ll have a combination of oxycodone or hydrocodone with Tylenol.
Your doctor may also have you continue taking Celebrex, Oxycontin, or gabapentin.
6
No
Pain
Mild
Pain
Moderate
Pain
Severe
Pain
Very Severe
Pain
Worst Possible
Pain
Pain messages are sent to the brain by chemicals traveling through many pathways. Recent
studies have shown that effective treatment of pain requires targeting those pathways with
particular medications BEFORE your surgery. This method not only treats pain more
effectively, but also reduces side effects after your surgery. As a patient at UMass Memorial,
it’s likely that you’ll be given a range of pain medications throughout your stay and recovery.
3
Prior to Your Surgery
An anesthesiologist may call you 1-2 working days before your surgery to answer any
questions you may have about anesthesia and pain management for your joint replacement
surgery. They may also check if there are any recent changes in your health condition.
On the Day of Your Surgery
When you arrive at the hospital, you’ll register with a preoperative nurse on the second
floor of the Memorial Campus at the Surgical Admissions Unit. You’ll receive pain
medication, which may include some or all of the following:
• Acetaminophen (Tylenol)
• Oxycontin (a form of oxycodone — an opioid, like morphine or hydromorphone)
• MS Contin (extended release morphine)
• Gabapentin (Neurontin)
• Celecoxib (Celebrex)
If you already take one of these medications, your dosage may increase. Please inform your
care team if you have problems with any of the above mentioned medications.
Next, you’ll be brought to a holding area on the third floor. Your surgeon will answer any
last-minute questions or concerns you have and place his/her signature on your body, at the
location of your surgery.
You’ll then meet your anesthesia care team which includes an attending anesthesiologist
and a Certified Registered Nurse Anesthetist (CRNA) or an anesthesiology resident (a fully
qualified physician who is pursuing an additional four years of training to become a Board
Certified Anesthesiologist). They’ll develop an anesthetic plan that is best for you. That plan
may include the following:
Anesthesia and Pain Control_Your Guide to OH Surgery 10/2/14 4:09 PM Page 5

4. management. For other patients, they might need a little extra pain medicine. If you
happen to fall into the latter category, all you have to do is call for the nurse. She will ask
if your pain is mild, moderate or severe. Based on the answer that you give her, that
corresponds to a different strength of medicine. You will most likely get one of four
narcotics that are offered: Oxycodone, Hydromorphone, Morphine or Codeine. You are
never abandoned from a pain perspective. Extra pain medicine is always available if you
need it.
Questions Our Patients Often Ask
Who will be treating my pain?
Answer: Your care team will treat your pain. The care team includes your nurse, orthopedic
specialists and acute pain specialists. Members of the Acute Pain Service will visit you the
first day after your surgery, or longer if necessary.
Will I get addicted to opioids if I take them?
Answer: Many people are afraid that if they take an opioid (like morphine), they’ll get
addicted. In fact, the number of people who become addicted to opioids is very small. With
that in mind, you should only take an opioid for the period of time your doctor says they are
needed. The amount of opioid you need should decrease over time as you heal from
surgery. When an opioid is used like this, the chances that you might become addicted are
very, very small.
You shouldn't be concerned to take these medications for several days, or even for several
weeks. Patients who are taking opioids before surgery may require a longer period of time
to wean themselves off the use of opioids.
Will I have a button to press to give myself IV pain medication?
Answer: We do not routinely give patients pain medicine using a “pain button” or PCA.
We have found that pain is often better controlled using oral medicines and occasional IV or
IM doses. A “pain button” will be available to patients whose pain is not able to be well
controlled with oral medications.
5
Anesthesia and Pain Control_Your Guide to OH Surgery 10/2/14 4:09 PM Page 7
• Spinal – An injection of local anesthetic into your back, which numbs the body below the
waist. The spinal anesthetic lasts 3 to 4 hours and wears off while you’re in the recovery
room. Along with the spinal anesthetic we will give other sedative medications through
an intravenous line (IV) to keep you comfortable and sedated during your procedure in
the operating room.
• General Anesthesia – This anesthetic technique involves giving medication through your
IV to make you unconscious and then securing your airway with a breathing device. You
will breath anesthetic gasses throughout the whole surgery to keep you unconscious.
When the surgeon is done, the anethetist shuts the inhalation gases off, removes the
breathing device and takes you to the recovery room.
• Nerve Block – An injection of local anesthetic that numbs the area where the nerve
provides sensation. Most of the time it is given to you in the holding area before you enter
the operating room or afterwards in the recovery unit.
There are two types of nerve blocks; your anesthesia and surgical team will determine the
best one for you:
• A femoral nerve block numbs the front of the knee and thigh. This nerve block lasts
anywhere from 12 to 16 hours and is often used for knee and hip replacements.
• In the second type of block, the orthopedic surgeon injects a long acting (24 to 48 hours)
local anesthetic in the operating room to provide significant pain relief after the surgery.
A catheter can sometimes be placed next to the nerve during the block procedure to
lengthen the time a nerve block will last.
Pain Control after Your Surgery
In the recovery room, you’re always monitored until your vital signs are stable and your pain
and/or nausea are well controlled. At this point, you’ll be brought to your hospital room. If
you have had spinal anesthesia, you’ll go to your room once the spinal begins to wear off
and you can wiggle your toes.
Over the next few days, you’ll be kept on the Gabapentin, Tylenol and/or Celebrex that you
were given in the Surgical Admissions Unit. You will be given this cocktail of drugs every
8-12 hours during your hospital stay. For some patients, this is all they require for pain
4