CONTROLLING PAIN: Treating pain after a total joint replacement

May 2006 
Volume 36  Number 5
Pages 26 - 28
  PDF Version Available!

QUESTION: My patient, age 68, had a total knee replacement yesterday. She has a patient-controlled analgesia (PCA) pump infusing morphine and rates her pain at 3 to 4 on a 0-to-10 pain intensity rating scale. During physical therapy, her pain increased to 6. How can I make sure she gets optimal pain relief?

ANSWER: Controlling pain from any joint replacement surgery requires a multimodal approach. Let's look at the options for the postoperative period.

PCA pump: Patient in control

The PCA pump is a good pain management option for patients who've had total joint replacement. For most opioid-naive patients, the standard PCA settings using morphine, hydromorphone, or fentanyl are sufficient for pain relief. Continuous or basal infusions on PCAs are no longer recommended because they contribute little to pain relief and increase the patient's risk of oversedation or overdose. Instead, the patient ...

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