Pioneering TreaTmenT Continued from page 5
up and walking shortly after Hip replacement That patient was Roger Kurtz, 60, from Bethel Park, a retired auto-
orthopaedic surgeon who just happened to be on-call, she needed a new hip joint. “He’s a great person and a great surgeon; he told me I was his
motive interior repair specialist who spent his workdays outdoors, on his
star patient. I was lucky that he was on call. He gave me a new hip and I
feet and often in contorted positions that led to osteoarthritis in his hips.
was only in the Hospital for a day and a half. I went to rehab for a week
Kurtz had his left hip replaced one year ago, using conventional methods,
and came home on Christmas Day. I had almost no pain and I never took
and he had the right one done in early November; both were done by
anything but Tylenol.” Sasser came home with a walker but used a cane
Dr. Perricelli. “I went in with a list of 25 questions and he answered
instead, for just a few days. She has already finished her physical therapy
every one without ever looking at his watch. After my first operation,
and is eager to get back to her activities.
I came out of the O.R. with a drain in my hip, a catheter, IVs and morphine. I was in bed all day and in the hospital for four days. I went home on crutches. The surgery in November was nothing like that. I was out of
changing old Procedures Implementation of the multimodal pain protocol was an enormous
bed that evening and walking. I had PT the next day and I never needed
endeavor for Dr. Perricelli, involving more than six months of design,
any morphine. I went home in two days with just a cane; I took oxycodone
development and research. It required not only a change in procedures,
for three days and then switched to Tylenol.
but also a shift in beliefs and attitudes. He conducted several in-service trainings for staff, educating the nurses, aides and physical therapists about the protocol and helping them view pain management in a new
“
way. “We had to change the way people think,” he says. “In the past, pain
i was out of bed that evening and walking, and had physical therapy the next day.
”
management meant major narcotics like opioids and then managing all their adverse effects; what I am doing is counter to everything the nurses and I have been doing for years. I wanted the staff to understand the process and embrace this. The staff grabbed the concept and ran with it. They’re with the patients 24/7 and they taught me a lot about how to make the entire protocol better.”
ROGER KURTZ HIP REPLACEMENT PATIENT
“It took some getting used to,” says Sandy Stanley, BSN, MS, a charge nurse for St. Clair’s Center of Orthopaedics, “but the nurses like it and think it’s working well. It’s been amazing. We’re used to giving narcotic pain medications, but Dr. Perricelli’s patients don’t even use the word ‘pain.’ Instead they might say that the knee aches,” she says. Dr. Perricelli’s patients are getting up and walking on the day of surgery, and going home one day earlier, in general, she says. “I give him a lot
Roger Kurtz
of credit for preparing his patients so well, too; when the patient knows what to expect, they experience less stress.” Cindy Crock, R.N., has been a Recovery Room nurse at St. Clair
In rehab, my PT told me that I was three or four weeks ahead of
Hospital since 2008. She has cared for hundreds of joint replacement
schedule with my walking. I can tie my own shoes again! My advice to
patients and she’s enthusiastic about Dr. Perricelli’s pain regimen.
people who need joint replacement is this: first, don’t be afraid; second,
“It’s wonderful; it solves and prevents problems. Typically, after TKA,
don’t put it off too long; and third, go to Dr. Perricelli. He said to me,
when the spinal anesthesia wears off, the patient needs a femoral nerve
‘Roger, I can take care of you.’ And he did.”
block in the Recovery Room. It takes away some of the pain and lasts a few hours. They also need a pain pump. This can be hard on the patient.”
Tylenol was all she Took Barbara Sasser never planned to have joint replacement surgery.
Dr. Perricelli's patients do not need either and they are stable enough to leave recovery in under an hour, while the norm is 90 minutes.
At 77, with an active social life, she had no known history of arthritis or
David Mayer, CRNP, has worked in orthopaedics for 33 years. As the
osteoporosis. But in the wee hours of a Sunday in December, she found
nurse practitioner with Dr. Perricelli’s practice, South Hills Orthopaedic
herself in the Emergency Department of St. Clair Hospital with a fractured
Surgery Associates, he makes daily post-op rounds on knee and hip
hip. She had fallen during the night and, according to Dr. Perricelli, the
replacement patients. “I’ve never seen anything like this,” he says.
6 I HouseCall I Volume VI Issue 1