Planning A Total Knee Replacement? Questions to Ask Your Doctor About Pain Management

Posted: November 17, 2017 | Word Count: 987
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A Total Knee Replacement (TKR) is one of the most commonly performed orthopedic procedures. In fact, the number of TKRs performed annually in the United States is expected to grow exponentially to 1.5 million additional procedures by 2030.1

If you are currently talking to your doctor about a TKR, you may have questions about pain management. It is one of the concerns for patients who are considering a TKR.2

In the U.S., 99 percent of surgical patients are prescribed post-surgical opioids,3 but they may not always be the best choice for everyone. Some patients hesitate because they are worried about the side effects of opioids, such as nausea and drowsiness, that may keep them off their feet and disrupt their daily life for an extended period of time. Others worry about addiction. A recent study found that 53 percent of knee-replacement patients were still taking opioids six months after surgery, with a higher incidence among those who also took opioids for pain management in advance of surgery for their chronic pain.4

Thanks to recent advances in pain management, there are non-opioid options to effectively manage pain. One option is EXPAREL® (bupivacaine liposome injectable suspension), a long-lasting local analgesic targeted at the surgical site. EXPAREL is not a pill; it goes to work directly at the surgical site via an injection administered by a surgeon, and numbs the pain in the area on your body where surgery was performed. It is non-opioid and is not addictive.

Some might wonder whether a non-opioid option could manage pain as efficiently, or for as long. A recent study published in The Journal of Arthroplasty found a 78 percent decrease in opioid consumption and significant reduction in pain scores with the use of EXPAREL. Ten percent of patients required no opioids for pain control post-surgery.5

If you are considering a TKR, there are a few things about pain management you will want to keep in mind. Pain management after surgery has a significant impact on recovery.6 The best way to prepare is to talk to your doctor about your concerns and preferences during your consultation. Pain is a personal experience and an informed conversation with your doctor may lead to better post-surgical outcomes related to pain. You should also be clear about how you may want to manage your post-surgical pain, whether opioid or non-opioid based.

Here are some questions to consider as you prepare to speak to your doctor about a pain management plan:

1. How much discomfort is usually associated with this procedure? Some pain after surgery is normal but everyone’s experience is different. Ask your doctor to explain how pain progresses and subsides with a typical TKR. It is also important to understand how you are personally managing pain now and the impact that will have on your recovery.

2. What can I expect in the first few days after my procedure? It’s important to talk to your doctor, who can help you understand how long it might take to get back to doing the things you love. EXPAREL works directly at the surgical site – unlike opioids, which affect the whole body.

3. How will my pain management plan be impacted by other medications? Be sure to share your entire medical history with your doctor in advance of a TKR. This includes all medications, both prescription and over the counter, that you take regularly in advance of your TKR. Being clear about the type of pain management treatments you are taking now can help inform your doctor’s plans for pain relief post-surgery.

4. What are the signs or symptoms that I need to adjust my pain management plan? Everyone responds to pain differently. Communicate with your healthcare team to help make your recovery as pain free as possible. You also should have a clear pain management plan and milestones for adjusting your pain relief medications.

5. Am I a good candidate for EXPAREL? Your pain management program should be personal. If you are interested in a non-opioid treatment option administered during surgery be sure to ask your doctor. Your doctor can advise if you are a good candidate and work it into your treatment plan, if appropriate.

Create an open dialogue with your doctor in advance of your TKR. Your pain management is your decision.

EXPAREL is indicated for administration into the surgical site to produce post-surgical analgesia.

Important Safety Information

EXPAREL should not be used in obstetrical paracervical block anesthesia.

In studies with EXPAREL, the most common side effects were nausea, constipation and vomiting.

EXPAREL is not recommended for use in patients younger than 18 years of age or in pregnant women.

Tell your healthcare professional if you have liver disease as this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from your body.

EXPAREL should not be injected into the spine, joints or veins.

Other local anesthetics should not be injected immediately after injecting EXPAREL; this may lead to an immediate release of the active ingredient in EXPAREL.

The active ingredient in EXPAREL can affect your:

· Nervous and cardiovascular system,

· May cause an allergic reaction,

· And/or if injected into your joints may cause damage to the joints.

1. GlobalData, Orthopedic Devices [Knee Reconstruction] Market, United States, 2009-2023, Absolute Units, 2017

2. Barlow T, Griffin D, Barlow D, Realpe A. Patients' decision making in total knee arthroplasty: a systematic review of qualitative research. Bone Joint Res. 2015;4(10);163-169.

3. Kessler ER, et al. Pharmacotherapy. 2013;33:383-91

4. Goesling J, Moser SE, Zaidi B, et al. Trends and predictors of opioid use following total knee and total hip arthroplasty. Pain. 2016; 157(6):1259-1265.

5. Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplasty. 2017:1-7. doi:10.1016/j.arth.2017.07.024.

6. Barrington, JW, Expert Working Group on Anesthesia & Orthopaedics: Critical Issues in Hip and Knee Replacement Arthroplasty. Am J Ortho 2014; 43: S1-S16

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