Quote from: Michael J. Assayag, MD on June 13, 2020, 03:16:23 PMThe best pain management method is a multimodal method.

It needs to be classified by type of pain:

Surgical and post operative pain, Lengthening pain, neuropathic pain, or pain related to complications such as unstable construct, Deep venous thrombosis or stress fracture.

1) For surgical and immediate post operative pain, Epidural is recommended. It helps with immediate rehab while in the hospital.
We also use tylenol around the clock and Toradol which is a strong anti inflammatory for 24hours after surgery. Low dose opioids such as oxycodone or TRAMadol are recommended for breakthrough pain  although they are highly addictive. Opioids should be the first medication to be stopped.

2) I recommend tylenol throughout the course of lengthening as pain managemwbt adjunct.
Non Steroidal Anti Inflammatory Drugs (Nsaids) such as ibuprofen, naproxen  had a bad reputation for a while as they were blames for poor bone healing but this myth has now been debunked They are very safe to use during lengthening. Opioids have actually been correlated with delayed bone healing more than NSAIDS

3) sometimes during lengthening, patients may develop neuropathic pain from nerve stretching
the first pain management method in those instances should be to slow down lengthening and allow some nerve recovery


Gabapentin or Pregabalin can be used to decrease nerve pain

4)pain related to complications such as blood clots or stress fracture are best treated by management of the underlying complication. This is why thorough followup is required by the surgeon. Pain related to muscle tightness can be alleviated by night time bracing and aggressive physical therapy

Hope this helps! don’t hesitate to PM me if you need more information

Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
www.limblength.org
[email protected]
@bonelengthening on Instagram

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