New technique alleviates pain for patients undergoing surgery

Some U hospital patients will be going home earlier than they have been.

Anesthesiologists at the U School of Medicine and hospital have developed a way to determine precisely how much medication is needed to relieve pain in major surgery patients who have become tolerant to opioids, the primary drugs used to relieve post-operative pain.

The new research is why U anesthesiologists were chosen from hundreds of presentations for the top award for their presentation on pain control at the International Anesthesia Research Society meeting in Tampa, Fla.

Researchers are also using two other new techniques that alleviate post-operative pain and shorten hospital stays for people who have had total knee replacements, surgery on their anterior cruciate ligaments or who have experienced fractures or other injuries of the lower extremities.

Assistant professor and co author of the research, Jennifer Davis, said the results have been great.

“This is a way to individualize each person’s pain,” she said.

Patients who have built tolerance to Lortab, OxyContin and other narcotics have had pain after surgery because standard post-operative doses of morphine haven’t worked, said Davis and Jeffrey Swenson, associate professor and co-author.

“Compared to five years ago, there’s a huge number of people coming into the hospital already taking narcotics,” Swenson said. “You give them medication and, unfortunately, it doesn’t touch the pain.”

Anesthesiologists developed a method that takes into account a patient’s opioid tolerance and helps physicians determine the amount of medication to stop post operative pain in people who already take a daily narcotic prescription.

Before receiving general anesthesia, patients are given fentanyl (a synthetic opioid used for pain control that is 100 times more potent than morphine) until respiratory depression is induced.

Doctors can look at pain receptors in the brain and determine patients’ tolerance.

By testing each individual’s response to fentanyl, anesthesiologists are able to predict a safe and effective dose of pain medicine that is individualized for each patient.

This method has only been practiced at the U and has become the standard protocol for surgery patients.

Other contributors to the study include doctors Talmage Egan, Kenward Johnson and Jeffrey Dillon and medical student Robert Hall.

U anesthesiologists are also using a new method to control post-operation pain in the 40 to 60 people who undergo knee surgery every month at the U.

A fascia iliaca catheter, also called a femoral block, is being placed in a space near the nerve without touching it instead of being placed right next to the nerve to administer local anesthetic.

As a result of this method, patients have been going home a full day sooner.

They have also been using a similar technique in ankle fractures or other injuries below the knee, which has allowed patients to go home three to four days sooner.

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