When I had my first hip replacement, they put me on a morphine-pump that I could operate myself. I could push the button every 10 minutes and get a small dose of the painkiller. The problem with that were the terrible side effects. It made me so nauseous, I could hardly stand up in therapy to walk. That was five-years ago. Now that I'm ready for my next hip surgery, I'm checking to see if things have improved. I hate the thought of going through that again.
Patients are surprised after a total hip replacement by how much it can hurt those first few days. They do okay while sitting or resting, but once they get up to move it can be another story. That's why surgeons are working hard to find ways to control pain. And they would like to do so without using opioids (narcotics) because of the many side effects.
Patient-controlled analgesia (PCA) can be a wonderful tool for many patients. Being able to control the release of pain medications can help get them back on their feet and smooth recovery. But as you discovered, not everyone has a good result with PCA.
Nausea, vomiting, itching, trouble breathing, confusion, and even delirium are all potential side effects of opiate-based (narcotic) drugs. For some patients, these adverse effects can be worse than the pain they are trying to control!
Some surgeons have started a new approach. That's the use of nerve blocks for the first 24 to 48 hours after surgery. There are different approaches being tried right now. Different types of nerve blocks are under investigation. By injecting a numbing agent around the nerve to the muscles in the hip, pain can be reduced.
Single-injection blocks can be delivered to the femoral nerve or higher up in the spine at the lumbar plexus. These provide pain relief for a short time after surgery. But for those first two days after surgery, continuous nerve blocks work much better. In particular, the lumbar plexus nerve block seems to have the best results. Patients use less (if any!) narcotic, which means fewer drug side effects to interfere with therapy.
Tell your surgeon about your concerns. Ask what other options might be available for you. If he or she doesn't mention a nerve block, you may want to ask if this is a possibility. The continuous infusion of a numbing agent seems to work best. This option isn't available everywhere, and not all surgeons have adopted this strategy. But it's worth asking about.
Joseph Marino, MD, et al. Continuous Lumbar Plexus Block for Postoperative Pain Control After Total Hip Arthroplasty. In The Journal of Bone & Joint Surgery. January 2009. Vol. 91A. No. 1. Pp. 29-37.
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