There is a lot of talk about patient satisfaction in healthcare. I think that we need to do more than talk about it. We need to do something about it. It starts with what patients want. I am fortunate that my surgeon is a huge patient advocate. Lets talk about his approach to pain management because I am laying down now with my knee elevated with pain 1 out of 10. Second day after surgery. 1 out of 10. I am a satisfied patient.
Multimodal pain relieving strategies are real. For my surgeon this means starting with NSAIDS (Alleve) preoperatively, intravenous Tylenol (Ofirmev), injections of the knee that include plain bupivacaine (lasts 12 hours), liposomal bupivacaine (Exparel- lasts 24-72 hours) and tranexamic acid (for bleeding control). The total cost of these injections which now leave me with minimal pain on the second day is approximately $350. That’s it! Now that’s a value for patient satisfaction. I heard recently about a hospital that is removing the intravenous Tylenol and the Exparel because- get this- it cost them too much and they did not achieve improved length of stay. I have seen this operation from both sides now and last I looked in the pecking order of things that make patient’s satisfied pain control dominates. In a $20,000 operation, a hospital or surgeon that is not willing to spend $350 of that on pain control just does not care about patient satisfaction.
As I mentioned in yesterday’s post I exercised quite a bit and was very sore at night. As predicted I had more soreness than I wanted so I took Tylenol 650 mg and oxycodone 10 mg twice last night. So in summary that’s all the opioids I took in 48 hours. When I woke up this morning I went back to Tylenol and Alleve.
Because of my preop physical therapy session I am on target with the exercises using the walker for getting around. I am also using my incentive spirometer to inflate my lungs to prevent pneumonia. This is a video from my surgeon’s site that shows how to use this:
Today is my first day where I am allowed to shower. The simple things. Showering took about 45 minutes but it went well. Wrapped the knee with Saran Press and Seal and kept everything dry even though I have a waterproof dressing (Aquacel).
Here is my Day 2 review:
Hi, I’m Dr. Kirschenbaum. This is post-operative day two. It’s Wednesday. I had the surgery on Monday. I’m going to go through my SwiftPath checklist, my multi-modal therapy.
I’ve been using my ice packs, my anti-inflammatory and tylenol. I only used narcotics twice in the last 48 hours, only 10 milligrams of oxycodone on two separate occasions. I elevate my leg using a firm pillow. I’m doing my 10 ankle pumps every hour. I’m reviewing the exercises on my surgeon’s landing page. I’m continuing my anticoagulation. My protocol is Lovenox, which I will start today. I was on Coumadin up until today, and I have sequential compression devices for my feet. I use my incentive spirometer at least once every hour, and I move slowly from a laying to a standing position. I drink plenty of fluids. I have smaller meals more frequently. I haven’t needed a laxative yet to prevent any constipation. As far as wound care goes, today I was able to take a shower using a shower chair. Fortunately, the shower had a handheld head that I was able to use. I wrapped the leg with a grab-and-go Saran wrap. My dressing, also, is waterproof, as well, so it was a double layer. I think that was a simple thing, but not as simple when you have some knee discomfort.
That’s my post-operative day number two story.