When a Knee Replacement Specialist Needs His Own New Knee

Ira H. Kirschenbaum, MD

Disclosures

September 07, 2016

In This Article

Surgery Day

August 22, 2016

I got to the surgery center at about 6 AM. Everyone there knew the entire protocol, knew what to do, and knew what I needed to do. It is not that I am surprised, but I am pleased it happened that way. After an interview with the intake nurse and then the anesthesiologist, the circulating nurse walked me to the operating room.

The surgery ended at 9:30 AM. I am recuperating at the home of my surgeon, a personal friend. I was in his house before noon. It is now 5 PM. I have no pain. I received a long-acting local anesthetic during the procedure. It's still working. But I know I have a long road ahead of me.

The pain would eventually arrive, and I needed to be ahead of it. I started taking two regular-strength Tylenol® (acetaminophen; 650 mg) every 4 hours while I was awake and two Aleve twice a day. I had some heavier meds in tow just in case. I also needed to be very compliant with my anticoagulation plan. I had started taking Coumadin® (warfarin) 5 mg the previous night and had just taken my second dose. After the third dose, I would be switching to Lovenox® (enoxaparin) for 10 days and then to aspirin for 6 weeks. I also had my portable sequential compression device (SCD) pumps to prevent deep vein thrombosis.

The Second Day After Surgery

August 24, 2016

There is a lot of talk about patient satisfaction in healthcare. I think that we need to do more than talk about it. We need to do something about it. It starts with what patients want. I am fortunate that my surgeon is a huge patient advocate.

It is the second day after surgery. I am laying down now with my knee elevated, with pain a 1 out of 10. I am a satisfied patient.

Multimodal pain-relieving strategies are important. For my surgeon, this means preoperatively starting with nonsteroidal anti-inflammatory drugs (NSAIDs—in my case, Aleve), intravenous Tylenol, injections in the knee that include plain bupivacaine (lasts 12 hours), liposomal bupivacaine (lasts 24-72 hours), and tranexamic acid (for bleeding control). The total cost of these injections, which now leave me with minimal pain on the second day after surgery, is approximately $350. That's it! Now that's a value to get patient satisfaction.

Recently I heard of a hospital that is removing the intravenous Tylenol and the liposomal bupivacaine because it cost them too much, and they did not achieve improved length of stay. I have seen this operation from both sides now, and of the things that make patients satisfied, pain control takes precedence. For a $20,000 operation, a hospital or surgeon unwilling to spend $350 of that on pain control just does not care about patient satisfaction.

In the first 2 days after the surgery, I exercised quite a bit and was very sore at night. I had more soreness than I wanted, so I took Tylenol 650 mg and oxycodone 10 mg twice on the second night. That's all the opioids I took in 48 hours. When I woke up the next morning, I went back to Tylenol and Aleve.

Because of my pre-op physical therapy session, I am on target with the prescribed exercises, using a walker for getting around. I am also using my incentive spirometer to inflate my lungs to prevent pneumonia.

In part 2 of this diary, I'll report on my postoperative pain management.

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