The Providence Joint Center provides a progressive pain management technique for patients. Jhunne Galimba, a former nurse with the Providence Joint Center and now a nurse practitioner with Providence Medical Group Cardiology, was instrumental in assuring patients are kept pain free during joint surgery recovery at Providence Medical Center. His article, “Promoting the Use of Peri-articular Multimodal Drug Injection for Total Knee Arthroplasty,” was published in Orthopaedic Nursing, a publication of the National Association of Orthopaedic Nurses (NAON).
The Providence Joint Center staff, medical director, and the hospital’s pharmacy, created a protocol and began using this method of pain management for joint replacement patients. Initially, the Joint Center used this method for elective knee and hip replacement. Later, it was initiated for use in shoulder replacements and specific forms of hip fracture repairs.
Their research showed that the intraoperative peri-articular injection and the postoperative injection of anesthetic/anti-inflammatory/epinephrine drug combination through an intra-articular catheter implanted in the joint space during surgery, appeared to be very effective in managing post-surgical pain.
The procedure effectively controls pain, decreases delay in joint mobility and reduces the need for systemic narcotics and the potential adverse side effects related to their use. In Galimba’s article, the results illustrated by his studies have been overwhelmingly positive.
“My article focused on total knee arthroplasty, comparing the safety and effectiveness of this technique with the traditional pain management methods, such as femoral nerve blocks, which we have used in the past,” Galimba explains. “The femoral nerve block provides effective pain relief, but it delays the patient’s mobilization. By inserting a small-bore catheter directly into the knee joint, and infusing a combination anti-inflammatory and local anesthetic via a catheter peri-operatively, the patient gains better control of their leg muscles. This promotes early mobilization.” In the Joint Center, this infusion, minus the narcotic (only included in surgical dosing), is repeated six hours post-operatively and in the early morning the day following surgery.
Galimba’s states that peri-articular injection of the drug combination is a safe, effective, and cost-efficient method of pain management for patients undergoing a total knee replacement, which reflects the results on its utilization at the Joint Center. “The first 48 hours after total knee surgery are crucial for pain relief,” Galimba says. “If we can control the patient’s pain initially, with the least amount of side effects, it really improves their ability to actively participate in therapy.”
Research conducted by the Joint Center’s staff on all joint replacement patients shows they achieved earlier functional recovery, as evidenced by a 46 percent increase in their ability to bear weight without buckling. Pain scores of less than 5 were achieved 85 percent of the time during the first 24 hours following surgery, using minimal rescue narcotics. Because the procedure has been so successful, it has been adopted housewide and is now used at Providence for all elective knee, hip and shoulder joint replacements, as well as certain hip fracture repairs.
The Providence Joint Center provides patients and their families with all the tools necessary for the best possible outcomes in total joint replacement. The program is a wellness-focused inpatient center that features surgical block scheduling, group physical and occupational therapy, pre-operative education, dedicated staffing, community outreach, resource management, reduced length-of-stay and patient amenities.
The Providence Joint Center’s multi-disciplinary team is composed of a group of orthopaedic surgeons, an orthopaedic operations and clinical resource specialist, staff nurses, a physical therapist, an occupational therapist and case management.