Marilyn Covers The Medical World With a Passion

Peripheral Nerve Blocks for Joint Surgery

It’s’ not exactly a new idea, Peripheral Nerve Block has long been used in obstetrics,  but in the last  8-years this type of anesthesia has grown up, become more sophisticated and that makes it definitely worth talking about –  especially if you’re about to undergo joint replacement surgery of any kind.    In fact, according to the American Academy of Orthopedic Surgeons, nearly 600-thousand Americans undergo total knee replacements every year.  Another 200-thousand receive new hip joints.

The Total Knee Replacement



Orthopedic surgery has always had a brutal and dangerous image.  I mean let’s face it sawing off the top of a bone is not easy to contemplate.   So it’s no surprise that despite often crippling joint pain, thousands delay joint replacements either because they had one joint replaced in several years ago and remember the god awful pain of recovery – or they’ve heard horror stories from friends or relatives.

Memories of the way it was

Bad memories kept 67 year old Karen Di Orio from the relief of total knee replacement for nearly a decade.  She explains “In 1988 I watched my father die just two days after joint replacement surgery.  That was always on my mind.”  Understandable, yet I find it odd that this petite woman with her clear, steady eyes and warm smile would let anything stand in her way.   I mean, I get the impression that Karen Di Orio has never let grass grow beneath her feet.  She is a determined woman who in the last 30 years has conquered mileage and mountains – 30-years of competing in marathons and triathlons.   In 2005 she climbed Africa’s highest mountain, Mount Kilimanjaro in Tanzania.  She says she has also scaled the Andes in South America’s.   Of course, the pounding eventually took its toll on her right knee joint.    Karen admits she did everything possible to avoid surgery but, she insists, not out of fear.  “I put it off because I was waiting for technology to change, to become more modern.”   Karen’s delay was arguably wise but with a price.  “For five years I had cortisone injections and then I tried anesthetic skin patches.  They helped, but only for a while.”  In September excruciating bone on bone pain stopped her cold.  Forget about running, forget mountain climbing.  Just walking up and down stairs was nearly impossible.  That sent her to orthopedic surgeon, Nicholas Sotereanos.   She said he patiently listened to her fears and then explained the changes and advances in joint surgery and anesthesia.   Karen gave up and gave in.  Her right knee was replaced Monday December 14, 2010.   She was sitting in a wheelchair awake, alert, oriented and totally pain free when we met the next day.

Better, safer anesthesia

Karen is proof, times HAVE changed so has anesthesia.   The scatter gun approach that used heavy narcotics to knock patients out while on the operating table is passé.    Today’s anesthetics are very refined, very specific, and much easier on the patient.    Dr. Florin Orza a highly skilled anesthesiologist and Director of the Acute Pain Clinic at Allegheny General Hospital here in Pittsburgh explains that “unlike Morphine and other heavy narcotics which metabolize in the liver making patients feel like they’re covered by a heavy blanket, newer anesthetics such as Remifentanyl offer a light-handed approach that blocks the pain at its source.  It’s like a gas stove, you turn it on for as long as you need it and when you turn it off it’s gone two minutes later,  It doesn’t stay in the body.”    Patients wake up immediately from general anesthesia alert and refreshed.

The OnQ Relief System by I-Flow

Even patients whose conditions might prevent general anesthesia can have pain free surgery.    The reason:  OnQ pump for Peripheral Nerve Block.  It’s actually local anesthetic that offers superb pain control to patients during and joint replacement surgery.

Warning to patients:   This is NOT used by just any general anesthesiologist.  Using OnQ  for joint surgery is a highly specialized skill.   In fact, of the twenty-five anesthesiologists at Allegheny General Hospital Dr. Orza is one of just three trained to perform this very specialized type of pain control.    Long used in obstetrics and gynecology to control pain after C-Sections and other gyne surgeries, OnQ was introduced for joint surgery less than ten years ago.

How OnQ works

Dr. Orza:  “We actually use ultrasound to place a thin catheter in the femoral nerve (marked in red in the drawing) and in the sciatic nerve, shown in dots, at the rear of the leg.   The OnQ ball is filled from the top port with Novocaine, the same stuff your dentist uses to numb your gums.”   The flow to nerves is controlled – depending how much or how little is needed.    Dr. Orza explained that a little goes a long way, “To avoid infection that may enter through the open cut in the skin, we only use OnQ pain control for two days after surgery, just until the worst of the bone pain is gone.  After that you’re good on oral narcotics for pain control.”

New technique blocks pain at its source


 Oh! What a relief it is

I can tell you from personal experience that the OnQ pain relief system is a godsend.  I know that Karen Di Orio agrees. She knows she can’t run anymore, but she’s okay with that.  She came through a total knee replacement without pain – and she still has no pain.  She will go home in a day or two and then begin rehabilitation.  Perhaps she’ll have a tiny bit of discomfort at first, but it won’t last enough to stop her from getting back on her feet – with no regrets.

Sources:  Dr. Florin Orza, Director of Acute Pain Control, Allegheny General Hospital Pittsburgh, PA.

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