Total knee replacements: A race to the bottom (KevinMD)
A total knee replacement is a very common operation and more than 700,000 of them are performed each year in the United States. With a mean cost of about $16,000 each, in 2011 we spent over eleven billion dollars paying for knee replacements. Projections are that, by 2030, we’ll be doing 3.5 million per year. The operation has great results and patients generally do well during and after their surgery.
Anesthetic care has improved dramatically over time. Whereas initially patients who had a knee replaced would be given large doses of narcotic pain medicines (morphine) to deal with their pain, over time anesthesiologists figured out that treating pain in different ways at the same time was better.
Patients began to receive spinals and epidurals in addition to or instead of general anesthetics and to be given non-narcotic medications in addition to their narcotics. In the present day, we provide nerve blocks to dramatically reduce the pain after surgery for about a day to give them time to get over their primary anesthetic. Patients benefited from the lower narcotic doses by feeling less drugged, being at lower risk for respirat...
