• Answering your questions about surgical anesthesia for orthopedic surgery
  • 90% of joint-replacement surgeries at HSS use regional anesthesia
  • Regional anesthesia has many benefits for the orthopedic patient

Anesthesiology

The Acute Pain Service

The Acute Pain Service (APS) at HSS is committed to reducing post-operative pain and assisting with the early phases of rehabilitation from orthopedic surgery. APS provides safe and effective pain management for all of HSS’ surgical patients.

The APS consists of a specialized team of clinicians with expertise in post-operative pain control, including anesthesiologists, nurses with special training in pain management, and pharmacists. Depending on your medical history and specific case, physicians from the Musculoskeletal and Interventional Pain Management Division may be consulted as well.

APS provides state-of-the-art postoperative pain control both in terms of analgesic medications and in the techniques used to administer them.  An anesthesiologist and a nurse from APS visit each patient on the service once or twice per day. If questions, concerns, or problems arise, a physician from the team is in-house 24 hours a day, seven days a week.

Comprehensive Pain Management

APS uses a multi-modal approach to control post-operative pain. This means that several different types of pain medications are used to help reduce pain in different ways. This approach to pain management helps limit the side effects of high doses of one pain reliever while reaping the benefits of pain relief from a different, complimentary technique.

Many of our patients will be able to use an analgesic technique called patient-controlled analgesia (PCA). This technique allows you to customize the delivery of your pain medication whether by intravenous, epidural, or continuous nerve block routes. These patients have the ability to give themselves additional small doses of pain medication on an as-needed basis. This flexibility allows the APS to address patients' individualized needs.

The APS sets limits and controls to help avoid side effects from pain medications. Extra doses can be given to control pain during peaks of discomfort which may occur during physical therapy. This method of pain management has been associated with higher levels of patient satisfaction, better pain control, and fewer side effects. Nonetheless, you may still experience side effects including nausea, itching, sleepiness, and numbness.

Patients are transitioned to oral pain medications, usually beginning on the first or second day after surgery, in anticipation of discharge.

Non-Narcotic Approaches to Post-Surgical Pain

Narcotic drugs, sometimes called opioids, used to treat pain may have side effects ranging from nausea and vomiting to addiction. While there is a need for some narcotics in many orthopedic cases, it is not the only pain control method your anesthesiologist uses to manage post-operative pain. In many cases, your anesthesiologist and APS will try to decrease the need for opioids during your recovery.

Epidural analgesia, nerve blocks, continuous nerve blocks, local anesthetics, and ice therapy are just a few non-narcotic approaches to pain control for patients following orthopedic surgery. Other non-narcotic approaches to pain management include anti-inflammatory drugs, anti-seizure medications and muscle relaxers that are used in tandem with other methods to help reduce pain after surgery. The use of alternative therapies, such as deep breathing exercises, may be incorporated into your treatment as well.