Becker's ASC Review

75 EXECUTIVE BRIEFING 2 EXECUTIVE BRIEFING How cold and compression therapy is improving patient outcomes and reducing the need for narcotics W hen it comes to orthopedic surgery, two of patients' most important questions are how long their recovery will be and how much pain they will experience. When addressing postoperative pain, physicians today are reluctant to include opioids in pain management protocols and patients are reluctant to take them. Fortunately, new and safer options are now available for pain management. Becker's Healthcare recently spoke with two pain management experts about how cold and compression therapy is improving patient outcomes and reducing the need for narcotics, both pre- and post-surgery, as well as in the physical therapy setting: • Dan Guttmann, MD, director of Taos (N.M.) Orthopedic Institute in Taos • Alek Johnson, manager of cast room and durable medical equipment (DME) services, Midwest Orthopaedics at Rush (MOR), in Chicago Motorized cold therapy with active compression offers safe, effective and affordable post- surgical pain relief Before and after orthopedic procedures, pain and swelling are common symptoms. This is particularly true with arthroscopic surgery, where surgeons must pump fluid into the shoulder or knee to see the work they need to do. After the procedure is finished, the joint is often very swollen. Simply applying cold alone isn't as effective as applying both cold and compression. Until recently, however, access to motorized cold therapy with active compression was limited to elite athletes. As this technology has evolved, however, the price of devices has come down significantly. This is good news for patients and clinicians alike. Dr. Guttmann specializes in shoulder and elbow surgeries. "Given the problem of opioid addiction in recent years, we are constantly looking for alternatives to help people with their pain," he said. "Almost every patient who has used motorized cold therapy with compression has said they are so glad they did. Many patients say they hardly needed any narcotics or anti- inflammatories at all. They also say that the ice is easy to use. It has made a huge difference in their pain and recovery and limited their need for medications." Midwest Orthopaedics at Rush has had similar experiences. "Where we are seeing cold and compression really make an impact in DME overall is during the first part of a patient's recovery," Mr. Johnson said. "That's when you would expect usage of pain medicine to be the highest. With Breg's Polar Care WaveTM, both the temperature and the compression can be controlled. It's definitely reduced the amount of medication that patients need immediately after surgery." For surgeons like Dr. Guttmann, this is very encouraging. "There are very few drugs that don't have some potential side effects," he said. "We've learned the hard way that even short-term usage of narcotics can be problematic. Drugs that are seemingly benign like ibuprofen and aspirin can also have problems. When I tell patients that they won't need narcotics as much or maybe at all after surgery, they really embrace that. The fewer medications a patient has to take, the better off they are." Cold and compression therapy is also beneficial prior to surgery and for nonoperative patients While cold and compression therapy has been a game changer postoperatively, it can also play an important role prior to surgery. "I now give cold and compression therapy to patients who are scheduling surgery," Dr. Guttmann said. "I want them to do some rehab before their procedure, but I don't want them hooked on narcotics. There is a lot of literature that shows people who use opioids before surgery don't do as well postoperatively. If you can minimize the use of narcotics preoperatively and use devices like Polar Care Wave, it really helps patients have a safer and faster recovery, and more predictable outcomes." One of the benefits of using cold and compression therapy preoperatively is that patients become familiar with using it. "There aren't a lot of bells and whistles with the Wave device. It has a good track record in terms of reliability and ease of use," Dr. Guttmann said. Polar Care Wave is also very portable. Dr. Guttmann asks his patients to bring the device with them on the day of surgery, since that is when the most swelling occurs. Dr. Guttman has also turned to cold and compression therapy for patients who may not need surgery, but are struggling with physical therapy. "To participate in therapy, you can't be suffering from a lot of pain," he said. "We are always looking for solutions which will allow patients to participate more consistently in rehab, like injections, medications or other things to augment pain relief. There's definitely an indication for using Wave as a nonoperative treatment."

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