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Pain Management in Joint-replacement Surgeries

Management Team

Pain Management in Joint-replacement Surgeries

Overview

Pain management is an important part of recovery and rehabilitation after any surgery.

Pain management in complex surgeries like joint replacement surgeries is a combined effort between the patient, surgeon, pain management team, and nurses. In such scenarios, pain management should be comprehensive, i.e., pain relief before the surgery, during the surgery, and after the surgery for a substantial amount of time. This strategy allows for early mobilisation, rehabilitation and faster recovery. 

Benefits

  • Reduced postoperative pain: Managing pain before surgery can help reduce the intensity of pain experienced after the procedure. This can lead to smoother recovery.
  • Lower stress levels: Preoperative pain management can help lower stress and anxiety levels, which can positively impact the overall surgical experience and recovery.
  • Improved mobility: Effective pain control can make it easier for patients to move and participate in physical therapy post-surgery, promoting better blood flow and faster healing.
  • Decreased risk of chronic pain: Addressing pain before surgery can reduce the risk of developing chronic pain conditions postoperatively.
  • Optimised pain medication use: By understanding a patient's pain levels and medication needs before surgery, healthcare providers can better tailor postoperative pain management plans, potentially reducing the need for long-term opioid use and its associated risks.
  • Enhanced overall recovery: Proper pain management can lead to fewer complications, shorter hospital stays, and a quicker return to normal activities.

Technique

  • Pain medications: Pain management medications must be taken as per instructions of your doctor or by visiting pain management clinic.
  • Pre-surgery physical therapy: Physical therapy prior to surgery reduces stiffness in joints. This helps improve muscle strength and flexibility and range of motion in the post-operative phase as well.
  • Ice packs: Ice packs help reduce pain and swelling. They should be applied for 10 to 15 minutes a few times a day or after physical therapy.
  • Healthy diet: A healthy diet supports tissue healing and helps maintain an appropriate body weight.
  • Deep breathing and relaxation techniques: These help in not only managing pain but also to stay calm and relaxed during surgery.

Effective pain management during surgery is essential for patient safety, comfort, and optimal recovery.

Benefits

  • Improved surgical outcomes: Effective pain management during surgery can lead to better surgical outcomes by reducing stress responses and improving patient stability.
  • Enhanced patient comfort: Proper pain control ensures that patients remain comfortable during the procedure, which can reduce anxiety and improve overall experience.
  • Reduced post-operative pain: Managing pain effectively during surgery can minimise the intensity of postoperative pain, leading to a smoother recovery.

Techniques

Anaesthesia: During surgery, pain is taken care of using anaesthetic medications.

Regional anaesthesia: Spinal, epidural, and nerve blocks, which numb a specific area of the body while the patient remains awake, are used to manage pain during surgery. RFH specialises in nerve block anaesthesia which involves injecting target nerves with local anaesthetics—with the help of special catheters placed near the nerve—to ensure that pain is taken care of intraoperatively as well as in the post-operative phase.

Multimodal analgesia: This technique combines different types of pain relief methods to target various pain pathways, thereby enhancing overall pain control during surgery and reducing the need for high doses of any single medication.

Risks

  • Tissue damage: Pain management during surgical procedures might result in tissue stretching or damage, which can cause pain.
  • Inflammatory response: Pain management during surgical procedures might inflammation
  • Nerve injury: Accidental damage to nerves during surgery can also occur with nerve blocks and epidurals.

What to expect in the recovery room?

  • Monitoring of your vital signs, including blood pressure, blood oxygenation, heart rate, etc.
  • Pain levels are also monitored and in case there is pain or discomfort additional intravenous medications are given.
  • Patient controlled analgesia: Patients are connected to a pump and can select and consume a dose of pain medication(s) by pressing a button.

Post-operative pain management is essential for enhancing recovery, minimising complications, and improving patient comfort following surgery. The main goal of pain management after any surgery is for the patient to comfortably awaken from anaesthesia and experience an uninterrupted transition to the post-operative period. Effective pain control facilitates early mobilisation, reduces the risk of chronic pain development, and improves overall patient satisfaction.

Benefits

  • Enhanced recovery: Effective pain management can lead to quicker recovery times, allowing patients to mobilise sooner and reducing hospital stays.
  • Improved patient comfort: Proper pain control significantly improves the overall patient experience and satisfaction.
  • Reduced complications: Managing pain effectively can lower the risk of complications such as thromboembolic events and respiratory issues.

Techniques

  • Medications: NSAIDs, acetaminophen, paracetamol, and other non-opioid analgesics are commonly used to manage post-operative pain with fewer side effects.
  • Epidural analgesia: Techniques like epidurals or nerve blocks can provide targeted pain relief, often reducing the need for systemic opioids.in post-operative phase.
  • Adductor canal block: Specialised nerve block which is given during the surgery and catheter inserted near the nerve through which local anaesthetic medications is given at regular intervals in post-operative period.
  • Ice pack and elevation: Helps in reducing swelling and pain.
  • Physical therapy: Gradual supervised gentle movements after surgery helps in earlier mobilization and aids in faster recovery.

Risks

  • Opioid-related side effects: These include nausea, vomiting, constipation, respiratory depression, and the risk of addiction.
  • Inadequate pain control: Poorly managed pain can lead to chronic pain conditions and prolonged recovery.
  • Adverse reactions: All pain management techniques carry some risk of adverse reactions, such as allergic responses or complications from regional anaesthesia.

  • Taking regular pain medications as prescribed by the doctors.
  • Ice packs and elevation.
  • Regular graded physical therapy as per physiotherapist recommendation.
  • Pacing activities.

If your pain is preventing you from normal daily activities even after doing all the above, kindly contact or visit your doctor.

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Pain Management During Labour

Management Team

Pain Management During Labour

Overview

Labour is characterised by rhythmic contractions of the uterus, essential for the cervix to dilate and facilitate the passage of the baby through the birth canal. While labour is a natural process, it can be intense and uncomfortable, varying in experience for each woman. Anaesthesia techniques like spinal and epidural anaesthesia can be used for labour pain management, ensuring a smooth and comfortable labour. Thus, pain relief strategies and pain management techniques aid successful and relaxed labour.

  • Relieve Pain: Make labour more comfortable.
  • Stay relaxed: Help you conserve energy.
  • Help labour progress: Manageable pain can make labour a smoother and happier experience.

  • Natural ways of pain relief without medication:
    • Breathing: To stay relaxed, it is important to pay attention to your breathing. Focus on slow, deep and patterned breathing.
    • Movement: Activities like walking, squatting, kneeling, or leaning forward can not only ease the pain but also help labour progress.
    • Massage: Circular light strokes, long strokes down the midback to sacrum, massaging the shoulders and neck and hip squeezes can provide comfort.
    • Calming or relaxing music: Music can have a calming effect during labour.
    • Practicing other relaxation techniques: Relaxation techniques other than medication (alongside medicated option) can help some people.
  • Medical pain relief options:
    • Regional anaesthesia: Labour epidural is the most common and effective pain relief during labour. Epidural analgesia involves the administration of medication near the spinal cord (epidural space) through a catheter inserted into the lower back. This method provides effective pain relief from the waist down, making it a popular choice for managing labour pain. It is administered by an anaesthesiologist and requires the woman to sit or lie in a specific position during placement. Epidural can also be used if caesarean section is required.
    • Combined spinalepidural (CSE): CSE combines the benefits of both spinal and epidural techniques. It begins with a single dose of pain medication injected into the spinal fluid for rapid pain relief, followed by the placement of an epidural catheter for ongoing management. This dual approach allows for precise control over the dosage of pain medications.

  • Temporary low blood pressure 
  • Spinal headaches
  • Itching
  • Allergic reactions to the local anaesthetic(s)
  • Fever or rare nerve complications 

These risks are carefully monitored and managed by healthcare providers.

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Paget's Disease of Bone

Management Team

Paget's Disease of Bone

Overview

Paget's disease of bone disrupts the body's natural process of recycling, old bone tissue is gradually replaced by new bone tissue. This can cause fragile and misshapen bones over time, particularly affecting the skull, pelvis, legs and spine. The likelihood of developing Paget's disease heightens with age and presence of family history. Potential complications include fractures, hearing loss, and pinched nerves in the spine.

  • Bones and joint pain
  • Tingling or weakness experienced in an extremity
  • Unexplained hearing loss, specially if it is unilateral
  • Bone deformities

The primary treatment involves bisphosphonates—medications that strengthen bones weakened by conditions like osteoporosis. Surgery may be required to address complications. Many individuals with Paget's disease experience no symptoms, but when they do arise, the most frequent complaint observed is bone pain. The disease causes the body to produce new bone at an accelerated rate, resulting in less organised and weaker bones, causing pain, deformities, and even fractures.

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Pulmonary Function Tests (PFTs)

Management Team

Pulmonary Function Tests (PFTs)

Overview

A complete pulmonary function test (PFT) is a thorough assessment used to evaluate lung function across various parameters. Conducted in a specialised pulmonary function laboratory, the test involves specific equipment, such as spirometers, body plethysmographs (for lung volumes) and devices for diffusion capacity (DLCO) measurements.

Before the test, patients are advised to avoid smoking, heavy meals, and strenuous exercise, with medication adjustments as needed under medical guidance.

The procedure includes several tests performed sequentially.

  • Spirometry is typically the first, measuring how much air a person can inhale and exhale and how quickly they can do so. This test helps diagnose conditions like asthma and COPD based on airflow limitations.
  • Following spirometry, lung volumes are assessed using a body plethysmograph or gas dilution techniques. This part of the test determines parameters such as Total Lung Capacity (TLC) and Residual Volume (RV), which are crucial for distinguishing between obstructive and restrictive lung diseases.
  • Next, a DLCO test is used to evaluate the efficiency of gas exchange in the lungs by measuring the uptake of carbon monoxide during a breath-hold manoeuvre. This is essential for diagnosing conditions affecting the alveolar capillary membrane, such as emphysema and pulmonary fibrosis.
  • Depending on clinical indications, bronchodilator response testing may also be performed to assess for reversible airflow obstruction.

Once baseline lung function measurements are established through PFTs, they provide a critical reference point for monitoring disease progression over time. Regular follow-up tests allow the pulmonologist to detect changes in lung function parameters, which may indicate worsening of conditions like COPD, pulmonary fibrosis, or asthma flare-ups. This monitoring aspect of PFTs is essential for predicting long-term outcomes and prognosis for patients, informing healthcare teams about the effectiveness of current treatments or the need for adjustments.

Moreover, based on specific diagnoses derived from PFT data (such as obstructive versus restrictive lung disease), healthcare providers can select appropriate medications like bronchodilators to alleviate airway obstruction or corticosteroids to manage inflammation effectively. Furthermore, measurements from PFTs, particularly DLCO, aid in determining the necessity and optimal dosage of supplemental oxygen therapy. For patients with severe conditions, such as advanced COPD, PFT results may also influence considerations for surgical interventions like lung volume reduction surgery or even lung transplant surgery in end-stage lung disease treatment.

Additionally, PFTs contribute to the design of pulmonary rehabilitation programmes aimed at improving exercise tolerance, optimising lung function and enhancing the overall quality of life for patients.

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Primary Ovarian Insufficiency

Management Team

Primary Ovarian Insufficiency

Overview

Primary ovarian insufficiency arises when the ovaries cease to function properly before the age of 40 years.

  • Genetic factors
  • Autoimmune diseases
  • Unknown reasons.

  • Hot flashes
  • Night sweats
  • Irregular menstrual cycle
  • Dry eyes
  • Vaginal dryness

Assessment of symptoms and hormone levels and sometimes genetic testing.

Hormone replacement therapy to manage symptoms and support bone and heart health. Fertility treatments or assisted reproductive technologies may be needed for women who wish to conceive. Emotional support and counselling can help cope with the psychological impact of primary ovarian insufficiency, improving overall well-being.

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Polycystic Ovary Syndrome (PCOS)

Management Team

Polycystic Ovary Syndrome (PCOS)

Overview

PCOS refers to a prevalent hormonal disorder in women linked to insulin resistance, obesity, and a heightened risk of type 2 diabetes and heart disease. If you are experiencing irregular periods, difficulties with conception, or notice excessive growth of hair on your face and body, along with acne or male-pattern baldness, it is advisable to consult a reproductive endocrinologist.

Excessive hair growth, irregular periods, ovarian cysts, and acne

Assessment of symptoms, blood tests to assess hormone levels, and ultrasound to view the ovaries.

Focuses on managing symptoms and may include lifestyle changes, hormonal birth control to regulate periods, medications like metformin to improve insulin resistance, and treatments for excess hair growth. Maintaining a healthy weight and regular monitoring are essential to manage PCOS and reduce complication risk.

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Precocious Puberty

Management Team

Precocious Puberty

Overview

Precocious puberty refers to the condition characterised by premature onset of puberty before the age of 8 in girls and before age 9 in boys. This can lead to rapid growth and development changes too early in life.

Hormonal imbalances, abnormalities in the central nervous system, or certain tumours. Early puberty can lead to emotional and social challenges, as well as an increased risk for short stature due to early closure of growth plates.

Blood tests to assess hormone levels, imaging studies, and sometimes a bone age assessment.

Aims to halt or reverse the early onset of puberty and can include medications like GnRH analogues, which delay further development until the appropriate age.

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Primary Aldosteronism

Management Team

Primary Aldosteronism

Overview

Primary aldosteronism occurs because of overproduction of aldosterone by the adrenal glands, causing high blood pressure and low levels of potassium.

Benign adrenal tumours or adrenal gland overactivity.

Muscle weakness, fatigue, and frequent urination.

Blood and urine tests to measure aldosterone and renin levels as well as imaging studies to identify gland abnormalities.

Medications to block aldosterone effects, lifestyle changes to manage blood pressure, and surgery to remove overactive glands or tumours. Early diagnosis and treatment are imperative to avoid complications like heart disease and kidney damage.

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Prolactinoma

Management Team

Prolactinoma

Overview

Prolactinoma is a benign tumour of the pituitary gland which causes excessive prolactin production.

Irregular menstrual cycles, infertility, and milk production in women and enlarged breasts, decreased libido, and erectile dysfunction in men.

Blood tests to assess prolactin levels and imaging studies like MRI to locate the tumour.

Medications to reduce prolactin levels and shrink the tumour. In cases for which medications are ineffective or cause severe side effects, surgery may be necessary to remove the tumour. Regular monitoring is important to manage symptoms and prevent complications.

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Pneumonia

Management Team

Pneumonia

Overview

Pneumonia is an infection of the lungs that can be caused by bacteria, viruses, and fungi.

  • Pneumonia is most commonly caused by bacteria, particularly Streptococcus pneumoniae.
  • Other bacterial pathogens include Haemophilus influenzae and Staphylococcus aureus.
  • Viral causative agents include Influenza A (including H1N1), COVID-19, CMV a.

  • Fever
  • Productive cough with purulent sputum (often yellow or green)
  • Mostly dry cough during viral pneumonia
  • Chest pain, which may be pleuritic (sharp pain that worsens with breathing or coughing)
  • Shortness of breath
  • Malaise, headache and muscle aches

  • Chest X-ray typically shows a dense area of lung infection in one or more lobes of the lungs.
  • Blood tests may show elevated white blood cell counts.
  • Sputum culture can identify the causative bacteria.
  • Throat swabs can also be used for diagnosis.
  • Occasionally, CT chest and bronchoscopy are also required.

  • Pneumonia is treated with antibiotics that target common bacterial pathogens.
  • Pneumonia caused by viruses can be treated with antiviral medications.
  • Supportive care, including rest, hydration and symptom management, is also important for complete treatment.
  • Hospitalisation may be required for severe cases, especially in elderly or immunocompromised patients.

Yearly vaccination for must be done to prevent influenza. Pneumococcal vaccination is recommended for old age patients suffering from lung disease and immunocompromised individuals.

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