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    Relief After Knee Surgery

    Anesthesiologist John Donovan’s study of post-operative pain management is of vital interest to the estimated half-million people who undergo total knee replacement surgery in the United States each year—and to Alta Bates Summit’s Research and Education Institute (REDI).

    John Donovan, MD dressed to do surgery on someone's knee
    “This is my first time doing something like this. I wouldn’t have been able to do it without REDI.”

    Anesthesiologist John Donovan, M.D., is participating in a pilot triple-masked, placebo-controlled study to test the effect of continuous femoral nerve blocks on readiness for hospital discharge following total knee replacement surgery.

    This is a multicenter study being done with the University of California at San Diego School of Medicine. Dr. Donovan hopes to enroll approximately 12 participants at Alta Bates Summit. He will work with a number of surgeons, including George Pugh, M.D., Tom Peatman, M.D., Jeff Mann, M.D., Ken Caldwell, M.D., and Joe Cheng, M.D.

    If the study is successful, total knee replacement patients may have the option of routinely leaving the hospital earlier and with pain relief managed by local anesthetic administered via a portable pump.


    Interview with John Donovan, M.D.

    Question:
    What is the primary objective of your study on total knee replacement surgery?
    Dr. Donovan:

    The main goal of this study is to reduce pain, but also we’re trying to help people to improve function. We’d like to see whether the quality and type of post-operative pain management we use affects long-term functional outcomes.

    Total knee replacement is a very common procedure. About 500,000 people have it done in the United States annually. And that number is expected to go much higher as the baby boomers get older because they have a higher expectation to stay active than did previous generations. It’s also a very expensive procedure. The implants themselves can be expensive, and there’s also the component of how long most patients stay in the hospital. It costs about $30,000 per procedure, and about $15 billion is spent on total knee replacement each year in the United States alone.

    X-ray of the knee after replacement surgery.

    Patients tend to stay in the hospital after knee replacement for two reasons—the need for potent opioid narcotic medications and the need for assistance due to the inability to get around. But in many surgeries, it’s becoming a recognized option to send patients home with peripheral nerve blocks. They’re currently being used for shoulder and ankle surgeries, and now we’re looking at nerve blocks for total knee replacement patients.

    By using a continuous peripheral nerve block for pain, knee replacement patients could actually go home with a catheter attached to a disposable portable pump that’s about the size of a Walkman and be infused for four days. In our study, participants can go home on post-op day three with the disposable pump and the nerve block, as long as they’re free of the need for IV narcotics and they’re able to walk. It’s cutting edge.

    Question:
    How would you describe your experience partnering with REDI?
    Dr. Donovan:

    I had heard that the hospital was supporting physicians who were interested in doing research through REDI, so I looked into it. This is my first time doing something like this. I wouldn’t have been able to do it without REDI. I would have tried, but I don’t think I would have succeeded, not having had previous research experience. I wouldn’t have had enough time or resources or experience.

    Four of the staff at REDI

    I’ve gotten great support from Vickie Nolan (research manager), who really helped with enrollment and consents. Enrollment is one of the biggest challenges when you’re in a private-practice setting because you have to get buy-in from a large number of people. We had to get buy-in from the pharmacy that it would be worth it to have one of their pharmacists randomize solutions. And we had to get buy-in from the nurses. There’s work for all of the parties involved.

    Kyle Hansen (director of REDI) has been great. He’s been very patient with getting this going. Also, Winston Lee and Kelly Harrison at the Summit Campus pharmacy have been great because they’re very busy and there are a lot of logistics involved with the pharmacy and randomization, but they were willing to participate in this.

    Question:
    Why do you think it’s important for Alta Bates Summit Medical Center to be involved in medical research?
    Dr. Donovan:

    I think it’s good exposure for Alta Bates Summit, and I think it also ties in nicely with the Orthopedic Center of Excellence. Alta Bates Summit does a lot of orthopedics and has the volume and level of care that’s consistent with a Center of Excellence. And I think part of that would be taking advantage of opportunities to do research.

    Question:
    Once this study is completed, do you anticipate that you will conduct follow-up or related research?
    Dr. Donovan:

    This is a pilot study that’s being done by a group called PAINfRE External Site, and they’re looking at trying to establish a multicenter group to do subsequent studies that will look at the use of ambulatory infusions for orthopedic surgery.