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UMassMemorial Medical Center A Member of UMass Memorial Health Care

Department of Orthopedics and Physical RehabilitationDivision of Arthritis and Joint Replacement Surgery

UMass Memorial Medical Center – University Campus

55 Lake Avenue North, Worcester, MA 01655

www.umassmemorial.org/ortho

UMassMemorial Health Care

Patients and families trust UMass Memorial Medical Center as

the region’s leading academic medical center, committed to

improving the health of our communities in Central New England.

With our partner, the University of Massachusetts Medical School,

we are committed to excellence in care, community service,

teaching and research. The Medical Center offers advanced

technology and support services for patients and families,

providing the region with specialists renowned for their expertise

in caring for adults and children.

Contributions to UMass Memorial Medical Center are deeply

appreciated. Call 508-856-5520 or email giving@umassmed.edu.

UMass Memorial Health Care is the largest not-for-profit health

care system in Central New England with more than 13,000

employees and nearly 2,000 physicians, many of whom are

members of UMass Memorial Medical Group. Our member

hospitals and entities include Clinton Hospital, HealthAlliance

Hospital, Marlborough Hospital, UMass Memorial Medical Center

and Community Healthlink, our behavioral health agency. With

our teaching and research partner, the University of Massachusetts

Medical School, our extensive primary care network and our

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Anesthesiaand PainControl forTotal JointReplacements

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About This BookletThe information provided in this booklet is intended to be your guide as you plan for your

upcoming total joint replacement surgery. This guide was written by your Arthritis and Joint

Replacement Center care team at UMass Memorial Medical Center in order to help answer

many of the questions you may have regarding your surgery and recovery. We hope you find

the information in this booklet helpful. We also encourage you to speak with your doctor or

member of your health care team if you have any additional questions.

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How often will I be able to get pain medication?

Answer: You’ll receive long acting pain medications twice a day, such as gabapentin and

Celebrex. You may receive an opioid, Tylenol, or a combination of the two for pain every

few hours. You’ll also have your backup intravenous and oral opioid medication, should you

need it. Please tell a member of your care team about your level of pain so they can better

treat it. They’ll show you a pain score chart to help you describe your pain (zero is no pain,

ten is extreme pain).

If I have a high pain score, will I always get pain medication?

Answer: Usually, but not always. Depending on the side effects of medications (sleepiness,

change in mental status, difficulty breathing, etc.), it may be safer to wait. Opioid

medications sometimes cause these side effects, but for at least 24 hours you’ll be closely

monitored to ensure there are no severe side effects from medications.

If you were on pain medications prior to your surgery, it might take longer to find the

correct dose after your surgery because your body is tolerant to the medications.

What about the nerve block I had earlier?

Answer: The nerve block will begin to wear off after 12 to 16 hours. As soon as it starts to

wear off, let a member of your care team know so that additional pain medications can be

provided.

What type of pain medication will I have when I leave the hospital?

Answer: Most likely you’ll have a combination of oxycodone or hydrocodone with Tylenol.

Your doctor may also have you continue taking Celebrex, Oxycontin, or gabapentin.

0 1 2 3 4 5 6 7 8 9 10

NoPain

MildPain

ModeratePain

SeverePain

Very SeverePain

Worst PossiblePain

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Pain messages are sent to the brain by chemicals traveling through many pathways. Recent

studies have shown that effective treatment of pain requires targeting those pathways with

particular medications BEFORE your surgery. This method not only treats pain more

effectively, but also reduces side effects after your surgery. As a patient at UMass Memorial,

it’s likely that you’ll be given a range of pain medications throughout your stay and recovery.

Prior to Your SurgeryAn anesthesiologist may call you 1-2 working days before your surgery to answer any

questions you may have about anesthesia and pain management for your joint replacement

surgery. They may also check if there are any recent changes in your health condition.

On the Day of Your SurgeryWhen you arrive at the hospital, you’ll register with a preoperative nurse on the second

floor of the Memorial Campus at the Surgical Admissions Unit. You’ll receive pain

medication, which may include some or all of the following:

• Acetaminophen (Tylenol)

• Oxycontin (a form of oxycodone — an opioid, like morphine or hydromorphone)

• MS Contin (extended release morphine)

• Gabapentin (Neurontin)

• Celecoxib (Celebrex)

If you already take one of these medications, your dosage may increase. Please inform your

care team if you have problems with any of the above mentioned medications.

Next, you’ll be brought to a holding area on the third floor. Your surgeon will answer any

last-minute questions or concerns you have and place his/her signature on your body, at the

location of your surgery.

You’ll then meet your anesthesia care team which includes an attending anesthesiologist

and a Certified Registered Nurse Anesthetist (CRNA) or an anesthesiology resident (a fully

qualified physician who is pursuing an additional four years of training to become a Board

Certified Anesthesiologist). They’ll develop an anesthetic plan that is best for you. That plan

may include the following:

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management. For other patients, they might need a little extra pain medicine. If you

happen to fall into the latter category, all you have to do is call for the nurse. She will ask

if your pain is mild, moderate or severe. Based on the answer that you give her, that

corresponds to a different strength of medicine. You will most likely get one of four

narcotics that are offered: Oxycodone, Hydromorphone, Morphine or Codeine. You are

never abandoned from a pain perspective. Extra pain medicine is always available if you

need it.

Questions Our Patients Often AskWho will be treating my pain?

Answer: Your care team will treat your pain. The care team includes your nurse, orthopedic

specialists and acute pain specialists. Members of the Acute Pain Service will visit you the

first day after your surgery, or longer if necessary.

Will I get addicted to opioids if I take them?

Answer: Many people are afraid that if they take an opioid (like morphine), they’ll get

addicted. In fact, the number of people who become addicted to opioids is very small. With

that in mind, you should only take an opioid for the period of time your doctor says they are

needed. The amount of opioid you need should decrease over time as you heal from

surgery. When an opioid is used like this, the chances that you might become addicted are

very, very small.

You shouldn't be concerned to take these medications for several days, or even for several

weeks. Patients who are taking opioids before surgery may require a longer period of time

to wean themselves off the use of opioids.

Will I have a button to press to give myself IV pain medication?

Answer:We do not routinely give patients pain medicine using a “pain button” or PCA.

We have found that pain is often better controlled using oral medicines and occasional IV or

IM doses. A “pain button” will be available to patients whose pain is not able to be well

controlled with oral medications.

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• Spinal – An injection of local anesthetic into your back, which numbs the body below the

waist. The spinal anesthetic lasts 3 to 4 hours and wears off while you’re in the recovery

room. Along with the spinal anesthetic we will give other sedative medications through

an intravenous line (IV) to keep you comfortable and sedated during your procedure in

the operating room.

• General Anesthesia – This anesthetic technique involves giving medication through your

IV to make you unconscious and then securing your airway with a breathing device. You

will breath anesthetic gasses throughout the whole surgery to keep you unconscious.

When the surgeon is done, the anethetist shuts the inhalation gases off, removes the

breathing device and takes you to the recovery room.

• Nerve Block – An injection of local anesthetic that numbs the area where the nerve

provides sensation. Most of the time it is given to you in the holding area before you enter

the operating room or afterwards in the recovery unit.

There are two types of nerve blocks; your anesthesia and surgical team will determine the

best one for you:

• A femoral nerve block numbs the front of the knee and thigh. This nerve block lasts

anywhere from 12 to 16 hours and is often used for knee and hip replacements.

• In the second type of block, the orthopedic surgeon injects a long acting (24 to 48 hours)

local anesthetic in the operating room to provide significant pain relief after the surgery.

A catheter can sometimes be placed next to the nerve during the block procedure to

lengthen the time a nerve block will last.

Pain Control after Your SurgeryIn the recovery room, you’re always monitored until your vital signs are stable and your pain

and/or nausea are well controlled. At this point, you’ll be brought to your hospital room. If

you have had spinal anesthesia, you’ll go to your room once the spinal begins to wear off

and you can wiggle your toes.

Over the next few days, you’ll be kept on the Gabapentin, Tylenol and/or Celebrex that you

were given in the Surgical Admissions Unit. You will be given this cocktail of drugs every

8-12 hours during your hospital stay. For some patients, this is all they require for pain

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