Fighting Pain, Transforming Lives: A New Model Of Care At St. Clair Hospital

Pain is a universal experience for us all – but in some cases, it can become so unbearable that medical interventions become a necessity to control or eliminate it. In fact, the pain and pain-related disability of osteoarthritis is what drives many people to orthopaedic surgeons in search of relief.

One of the surgeons being turned to in these cases is Brett C. Perricelli, M.D., of St. Clair Hospital’s own surgical staff. Dr. Perricelli specializes in complex hip and knee joint replacement surgery, and spends his days performing procedures known as total hip arthroplasty (THA) and total knee arthroplasty (TKA).

 But as Dr. Perricelli knows all too well, coming to the hospital is just the beginning of a patient’s journey in managing and addressing pain. And he wants to do something about it.

Why Treating Osteoarthritis Pain Is Surprisingly Painful

The procedures Dr. Perricelli specializes in were designed to restore the integrity and function of joints suffering from osteoarthritis, specifically those in our hips and knees. Unfortunately and even ironically, the very procedures designed to address joint pain are generally considered by surgeons to be among the most painful of all operations.

It makes sense though, when one thinks about the procedure and what it entails. To accommodate the implants made during replacement surgeries, a surgeon makes multiple cuts in several large bones. The surgeon must then shape the ends of the femur and tibia, and begin cutting out the arthritis to replace it with metal implants.

“It’s literally sawing the bone in multiple places,” Dr. Perricelli explains about the procedures. “There is also dissection of the soft tissue that has multiple nerve endings.”

It makes sense then that, even with pain medication and management techniques, such a procedure would be, well, uncomfortable. Worse, the resulting post-operative pain can actually be an impediment to recovery, as it can keep patients from adhering to their physical therapy regimens.

Clearly, pain is a major issue when dealing with osteoarthritis. That’s why Dr. Perricelli has begun taking action and doing more about it.

A New Approach To Addressing Osteoarthritis Treatment Pain

To help patients better deal with the pain associated with osteoarthritis and its treatments, Dr. Perricelli has begun a new protocol within the past year – and it has been so successful that he has no plans of ending its use now.

He now begins treating the pain of the condition before he even begins a surgical procedure.

His approach is based on the concept of altering the patient’s experience of pain and facilitating a faster, gentler and more comfortable post-operative recovery process and more successful rehabilitation. Referred to as his “Peri-operative Pain Protocol,” the strategy uses a regimen that is centered on multimodal analgesia — “hitting pain from many angles,” he calls it — and local peri-articular injections, given with exquisite precision into the surgical site.

In the “Peri-operative Pain Protocol” model, pain is controlled for up to three days after surgery, with effects that can last much longer. As a result, many patients find that they need to take fewer narcotics to manage their pain. This means fewer narcotic-related side effects, which can inhibit recovery and create complications that prolong length of stay, increase patient discomfort and drive up their treatment costs.

“Joint replacement surgery, and knee replacement in particular, are difficult for patients,” Dr. Perricelli explains. “They feel agonizing pain that is traditionally treated with narcotic painkillers that leave them groggy and nauseated. In the old paradigm, pain management means narcotics. My goal is to improve pain control throughout the peri-operative period — before, during and after surgery — in order to decrease narcotic use and minimize complications associated with narcotics. It gets patients back on their feet faster.”

A Look At the Peri-operative Pain Protocol

So how does Dr. Perricelli’s three-step program actually work?

“I begin treating pain and nausea before I start the surgery,” Dr. Perricelli says. “We know it’s going to happen, so why not get a head start on treatment? The pre-op protocol consists of giving the anti-inflammatories and an anti-nausea skin patch in the pre-op holding area.

“The second, intra-operative part of the protocol is more complicated. The patient is given spinal anesthesia, then IV Tylenol for pain, IV anti-nausea medication, an anti-bleeding medication, and steroids to prevent inflammation, which is a huge factor in pain. I give the two workhorses — the injections — right into the operative site. The drug Exparel is suspended in bubbles of fat, which slowly break down and release the medicine over 72 hours. I then inject other anesthetics, anti-inflammatory agents and epinephrine into the knee at any point where I think I’m going to cause pain. This is hitting the pain right where it happens. It’s a painstaking process and adds time to the procedure, but it’s worth it.”

The third step is the post-operative care of the patient, during which time patients are given the appropriate pain killers and medications needed to assist during their recovery time.

Dr. Perricelli is careful to emphasize that his three-step program does not equal pain-free surgery. It is, however, a more comfortable experience.

“The absence of pain and inflammation is the key,” he explains. “When you control the immediate pain and inflammation, the effects are longer lasting. It’s not like it wears off and then the patient is miserable.”

And so far, the results have been, in his own words, amazing.

“Seeing my patients looking comfortable after surgery is the most amazing experience. One was up and making his own bed when I went into his room the day after a hip replacement. I could hardly believe my eyes.”

Brett C. Perricelli, M.D.’s three-step regimen has made a tremendous difference in the recovery journey of many of his patients. He has become a trailblazer in his specialty, pioneering a revolutionary approach to total joint replacement that holds the promise of a new era in the field. His approach to controlling pain after hip and knee surgery represents a dramatic departure from the conventional approach. His protocol is not just innovative; it may be transformative.

To read more about the experience of the “Peri-operative Pain Protocol” from the patient’s perspective, click here to download Volume VI, Issue 1 of St. Clair Hospital’s HouseCall magazine.