GRANTS PASS, Ore. – Surgery can spark a lot of concerns, including cost, recovery time and the possibility of developing an opioid addiction. An orthopedic surgeon in Grants Pass is developing a new treatment plan to help ease all of those concerns.
Dr. James Van Horne has been in the valley for around 25 years, he’s raised a family here and is a highly regarded surgeon at Paragon Orthopedic Center. He specializes in knee and hip replacement surgeries. Now, after 10 years in the process, he’s seeing proven success with his alternative treatment plan.
It’s called “Patient Optimizing, Opioid Sparing, Enhanced Recovery” — a detailed treatment plan that has 84 percent of his patients entirely off of all narcotics just one week after a total hip or knee replacement surgery.
That percentage was gathered from around 600 of Dr. Van Horne’s patients. The average patient for a total hip or knee replacement surgery is spending around 3 days in the hospital recovering post-surgery, and around 30 percent of them are still using narcotics two months after surgery and sometimes longer.
“Patients, still today, the average is around three days and about 25 percent of people still go to skilled nursing facilities afterwards for weeks. It’s very expensive and we can’t continue doing that,” said Dr. Van Horne.
The alternative treatment starts with a detailed pre-op plan.
“We prepare the patients before surgery so they do well after surgery,” said Dr. Van Horne. Discussing things like weight control, blood sugar levels and overall health, “we find out what works for them in the way of pain control before surgery so after surgery they take less narcotics, recover more quickly, and hurt less.”
During surgery Dr. Van Horne injects the surgery site with anesthetic that releases at different times over a 2-3 day period.
“If you can get someone through the first 2-3 days of pain you prevent what’s called the 'pain cycle' from starting,” said Dr. Van Horne. “In 2 to 3 days they are able to come off of the narcotics and just be on Tylenol, vitamin C, nonsteroidal anti-inflammatories and other things for pain.”
The CDC recommends no more than seven days of narcotic use, it takes less than that to affect your brain.
“Even as short as 5-7 days of narcotic use can rewire your brain, it’s called neuroplasticity,” said Dr. Van Horne. “The neurons add new connections, new dendrites, that make your pain more painful, plus it makes you release natural endorphins so you actually get a high, with time.”
Through the anesthetic injection and delayed release immediately after surgery, many of Dr. Van Horne's patients are able to leave the hospital the same day of their operation. He claims that they also see a faster recovery.
“You get early range of motion, exercise early,” said Scott Byrd, a physical therapist for Sporthopedics and one of Dr. Van Horne’s patient. “That allows you to shorten your time in physical therapy — that’s the key, get it going faster. If you wait for five, six days before you start moving your joints it creates a crescendo of problems down the road; increasing your risk of a blood clot, increasing your risk of tightness in the joint and it lengthens your amount of time in therapy and it is more painful.”
Now Dr. Van Horne is starting to work with Asante in hopes of making the treatment more widely available.
“We’re working on as a study to find out whether my program can be rolled out to other surgeons,” said Dr. Van Horne. “We’re working with Asante right now to do a data mining project where we can evaluate all the different techniques see which ones are best and which ones we can roll out to other physicians.”
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