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Greenwich Hospital Honored For Pain Management

GREENWICH, Conn. – A team of doctors at Greenwich Hospital has been recognized by the Connecticut Hospital Association for a new approach to reducing pain and side effects of medication following joint replacement surgery.

The team, led by anesthesiologist Mark Chrostowski, will receive the 2012 John D. Thomas Award for Excellence in the Delivery of Healthcare Through the Use of Data at the association’s annual meeting on Wednesday. The award honors excellence in patient care through the use of data, as demon­strated by the improvement of internal operations, procedures and outcomes.

Total knee and hip replacement have become two of the most common surgeries performed in the U.S. However, post-op treatment of pain affects a patient’s ability to receive physical therapy.

The Greenwich team's approach begins before surgery by starting the patient on non-opioid medications to control pain and inflammation. A local anesthetic to numb the joint area is then given either by single injection or through a peripheral nerve catheter. The catheter is inserted through a needle and placed near nerves where post-surgical pain is expected. This is done using an ultrasound machine that allows doctors to see nerves, surrounding muscles and blood vessels and the medication as it spreads around the nerve.

Data collected from medical records and patient surveys showed a dramatic result from this approach. “Of the 424 patients for whom we collected data between January 2011 and February 2012, patients who received this new protocol, on average, used 40 percent less opioids during their entire hospital stay, and the average use of patient-controlled analgesia (morphine pump) decreased by 47 percent,” according to Chrostowski.

After surgery, the patient continues to receive non-opioid oral medications as well as a numbing medication through the peripheral nerve catheter, which is attached to a disposable pump.

Because opioid use was reduced, so were the side effects from these potent medications. For instance, nausea decreased from 31 percent to 16 percent and vomiting decreased from 17 percent to 8 percent. Itchiness decreased from 26 percent to 1 percent. Urine retention decreased from 32 percent to 9 percent. Patients also reported increased compliance with post-surgery physical therapy.

“The goal is to return each patient back to their regular activities with reduced pain and a better range of motion,” Chrostowski said in a prepared statement, adding that he sees potential for using this approach for patients undergoing bariatric, major gynecologic, oncologic and other types of general surgery.

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