email or text patients.
Brett R. Levine, MD, MS, a hip and knee reconstruction and replace-
ment specialist at Rush University Medical Center in Chicago, Ill.,
partners with a text-messaging service that lets him send essential
information to patients before and after surgery.
"My team and I studied about 100 patients to determine their most
common questions and concerns," says Dr. Levine. He then created
customized text messages to each one. Now his patients receive auto-
mated reminders and information about, for example, how they should
prepare for surgery and what to expect afterward. He's even able to
send them videos of exercises and physical therapy routines to keep
their recoveries on track.
The messaging service also provides patients with answers to questions
about relatively minor post-surgery concerns that in many cases they
used to call him about or for which they ended up in the ER for unneces-
sary treatment.
2. Multimodal analgesia
The current opioid epidemic and good clinical sense point to limiting
the use of opioids to manage post-op pain, but you should avoid the
push to do away with the powerful painkillers altogether.
"A completely narcotic-free recovery is not impossible for some knee
replacement patients, but the majority require a conservative use of
opioids," says Keith Berend, MD, orthopedic surgeon at Joint Implant
Surgeons in New Albany, Ohio.
Multimodal drug cocktails differ from provider to provider, but each
regimen is designed to stay ahead of pain and attack it from various
pathways. Dr. Berend augments a judicious use of opioids by adminis-
tering acetaminophen, long-term Cox-2 inhibitors and tramadol before
and during surgery.
1 0 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 8
