New technique can shorten hospitalization, ease pain after joint replacement, UF research shows

Knee replacement patients could enjoy shorter hospital stays and greater comfort with a precision pain management technique that delivers local anesthetic directly to the area it’s needed most, a University of Florida physician reported Saturday (6/26) at the Florida Society of Anesthesiologists meeting in Palm Beach.

The technique, commonly known as patient-controlled regional analgesia, involves placing a tiny tube called a catheter next to a major nerve pathway associated with the surgery site, then giving the patient a small, portable electronic pump to administer a local anesthetic.

After surgery, patients can use the pump in the hospital, then at home for up to four days. The catheter can be removed by the patient, following instructions given over the phone by a physician.

Preliminary results of a UF study showed 60 percent of knee replacement patients treated with the technique were ready for discharge from the hospital one day after the surgery, and the remaining 40 percent were ready two days after surgery, said Brian Ilfeld, M.D., a UF assistant professor of anesthesiology and the study’s principal investigator.

At UF and throughout the nation, the average time to discharge knee replacement patients treated with other pain management methods such as oral or intravenous opiate drugs or epidural infusion is four days, he said. Previous research indicates that patient-controlled regional analgesia also provides greater comfort and requires less side-effect inducing medication than other methods.

“This country spends over $12.5 billion dollars per year on joint replacements. The overwhelming majority of those are hips and knees,” Ilfeld said. “Most of that, over 50 percent, is just hospitalization costs, it’s not the cost of the procedure, the joint hardware, the surgeon or rehabilitation.”

If the technique helped just 10 percent of all U.S. joint replacement patients reduce their hospital stays by one day, it would save more than $182 million annually, he said.

“And this (technique) is certainly applicable to more than just 10 percent of the patient population,” he said.

UF doctors were among the first in the state to use the technique, Ilfeld said. The UF study, which involves knee, hip, shoulder and elbow replacements, is the first to investigate this analgesic technique on an ambulatory basis to improve patients’ comfort and decrease hospitalization time.