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Blocking Pain: A game-changer for spine surgery patients
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No pain pills post-surgery? It's possible with a revolutionary pain management program which utilizes nerve blocking to mitigate pain and reduce the need for opioids and other pain medications. In this episode, you'll meet the surgeon, Dr. Girard Girasole, the anesthesiologist, Dr. Theresa Bowling, and the Patient, Vince, who recently underwent spine surgery using nerve blocking and got his life back - pain free.
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One of the fears that a lot of my patients would have beforehand, I don't want to get hooked on medicine because it's all out there. And that's a fear. And if you take that away, you you know you're hitting a home run.
SPEAKER_01I never took one pain pill at all. Whatever it was, it worked. I recommend it to anybody. It worked for me. I haven't had a bit of pain, not one bit of pain, since the operation.
SPEAKER_03Welcome to More Life. In this episode, Hartford Healthcare's Jocelyn Mementa takes us behind the scenes to discuss a groundbreaking new approach to pain management during spine surgery, which utilizes nerve blocking and greatly reduces the need for postoperative narcotics. Jocelyn will talk with the surgeon, the anesthesiologist, and the patient, who all provide their unique perspective on this game-changing procedure. First, the surgeon, Dr. Gerard Girisoli, co-director of orthopedics at St. Vincent's Medical Center in Bridgeport, Connecticut.
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SPEAKER_03Girisoli, first of all, let's talk about the pain management program that you've developed here.
SPEAKER_00Well, we developed a, I think, a revolutionary uh state-of-the-art pain management program um for post-operative analgesia. And the goal of the whole um pain management program is to reduce the need for narcotics postoperatively, which I feel is is just a key element in getting the patients back to normal function.
SPEAKER_04Why was that so important?
SPEAKER_00Well, you know, in spine surgery, there's a couple things that have developed over the years. One, our technique. We've gone into more minimally invasive procedures. And two, the the equipment that we use. Both of these together have paramounted to better outcomes. You know, people undergoing spinal surgery would think, oh, I'm gonna be down for three months, out for six months, and that's not true. The way I've done my procedures and my colleagues here is that people are really in therapy two weeks after surgery and back to almost full activity by six weeks. That part of it is due to, like I said, technique and instrumentation. However, there's no doubt that there's a lot of pain involved with that. And the issue is like, well, if you're in pain, you don't move, and then you start taking narcotics, and that's a tough thing to wean people off. I would always go through, well, you're gonna get weaned off in a couple of weeks. With this new program, patients wake up and they really don't have a lot of post-operative pain, which enables us to get them out of bed, get them mobilized. And the most important thing is when people undergo spine surgery, predominantly it's for some kind of neural pain, right? They have pain in their leg, pain in their arms, or and they'll wake up and we cure that surgically. When we decompress the nerve, predominantly we cure that. However, where we go to get into the place, whether it's minimally invasive or an open procedure, in doing so, there's a pain involved with that. So they wake up now, they not only wake up with their leg pain gone, they wake up and their back pain or their neck pain if we do cervical surgery, they don't have pain. And the biggest and strongest organ we have is our mind. And if we can convince them that, wow, I have no pain, my leg pain that I've been dealing with for years is gone, and I can really get, I could see that I can get back to my functionality in a quick period of time. And I think that's revolutionized what we do.
SPEAKER_04It is so revolutionary that you can actually have a patient walking hours after the surgery.
SPEAKER_00We actually have patients not only walking after surgery, they're getting into, we have a whole uh in the institute here, we have a whole gym where we uh a simulation of a getting in and out of a car, walking upstairs, and trying to get people back to functional, normal functional activity. We have them doing it post-op day one, that night. Most of the cases are done early, and they're in that gym that night.
SPEAKER_04That's incredible, isn't it? This is incredible.
SPEAKER_00It's it's incredible. I mean, this has started Dr. Bolin, who and her group who organized this, it's came to me with this idea, and we put it together, and we're gonna have a paper that's gonna come out. I think all institutes will follow. I think it's one of the most extraordinary things to aid in the success of spinal surgery.
SPEAKER_04What's the biggest benefit for you, the surgeon?
SPEAKER_00Well, the end all is to have the patients do well. Just seeing patients who are so nervous in your office about having surgery, the unknown, it's always the unknown. You know, what am I to expect? And and coming in there and seeing them that night or the next day, and they're like sitting there and saying, wow, thank you. You know, I get so many now, thank you. I can't believe I waited to do this, or I can't believe I was worried. And the big thing, I mean, the big picture is not having to wean them off narcotics. And the fact that we, you know, in this day and age, we you know, there's a lot of press on on pharmaceuticals and opioid use, and there's a need for opioids. However, it got out of hand. And sometimes, no matter what your social economic status is, you can get used to this stuff. And it could be bad, and it's ruined lives for people. And now we don't have to really worry about it. And it's a lesson we learned. But I mean, I Dr. Bowman will speak to the statistics of how there was like no narcotic use. Zero.
SPEAKER_04Really lowers the risk for any kind of addiction.
SPEAKER_00Not only addiction, you know, complications after surgery not only have to do with the surgery itself. If you are, if you're if you're down and you're not walking, you can get pulmonary issues, you can get urinary issues. All of these things can, if you're, you know, intoxicated with medication and you're you know not moving around, can affect you. So it's cut out a lot of other complications that are not technically surgical related.
SPEAKER_04Let's talk about the case of the patient we're going to be interviewing later, Vince. Tell us about his case.
SPEAKER_00Well, Vince had an interesting uh issue. Um, he had a surgery done many years ago at a smaller aspect of his lower spine, and he developed a deformity above that. So we had to do a surgery where we had to take, we go in and decompress him. And I was blown away that the next day or even that night I went to see him, and it was just incredible. And he's not just the only one. I mean, since we've done it, I've done numerous patients. We have a big study, and it was remarkable. He's a guy that was suffering for so long, and for him to get back to his functionality that quickly is just incredible.
SPEAKER_04So the biggest benefit for the patient is recovery time. Recovery time and the pain, of course.
SPEAKER_00I mean, all included. Pain, recovery time, success of their surgery, and just a feeling of well-being. I mean, we care about what they feel like. I mean, people don't want biggest one of the fears that a lot of my patients would have beforehand, I don't want to get hooked on medicine. Because it's all out there. And that's a fear. And if you take that away, you you know, you're hitting a home run.
SPEAKER_04Oh, absolutely. So let's go back to again the benefits for the patient. If you can just run it down one more time.
SPEAKER_00Sure. The benefits are not only do they, you know, obviously they don't have to suffer with pain afterwards, and because there can be painful operation, uh, um post-operative pain. Two would be their functionality. The quicker they can get back, if you're not in pain and you can move, then you can start doing the therapy. And, you know, people say in spinal surgery, oh, you shouldn't bend, you shouldn't do this. That's really, I try to fight that because when you go in again, if you make minimally invasive incisions or larger incisions, depending on the need of the patient, it still violates the normal anatomy. And the sooner you can get those muscles back to, you know, to functionality and to move, the better. So if you're not in pain, you're gonna be more opt to move and get up. You know, if you're in pain, you're gonna I'm not moving. But when you're when you're not in pain and you don't have to take narcotics, because narcotics take you out of pain, but they dope you up. So you don't have your mental ability. So think about it. You have your mental ability, you're not in that much pain, and it's tolerable, so you can get a better outcome. One of the things that this could lead to is like everything else in the world, we're moving to outpatient surgery. We do outpatient surgery, like we do small procedures in the neck, we do dysquectomies and stuff like that. These are in and out type of procedures. But like one-level fusions or a little more intricate procedures, we can start doing them with this type of block. Because it really can last 48 hours, and by the time the block kind of wears off, we've now learned with Dr. Bolin's help how to titrate the patient. So I think it's going to lead to uh surgeries that we can do outpatient.
SPEAKER_04Wow, that's great, because that's made that's used for patients.
SPEAKER_00Oh, it's incredible.
SPEAKER_04Well, thank you.
SPEAKER_00Thank you very much for having me.
SPEAKER_03Next, Dr. Teresa Bowling, Director of Orthopedic Anesthesia at St. Vincent's describes how the nerve block is administered and what the patient will and will not experience.
SPEAKER_02So the nerves that go from the spinal cord um exit by the bony um parts of your back where the surgeon is operating. So we're depositing the local anesthetic right between those muscle layers so that bathes the nerves in the local anesthetic and stops the transmission of pain. That local anesthetic will last about 48 hours. So another aspect of the procedure itself is um which makes patients very happy, is we do this after they're asleep. So they come to the operating room, we induce general anesthesia, and then after their position for the procedure, that's when we do the nerve block. So patients are very concerned about having another procedure and the pain associated with that. We do it after they're asleep. So when they wake up comfortably, they get the benefit of the nerve block without any um discomfort of having the nerve block placed. The other thing I should mention is this does not cause any weakness of the lower extremity. So some people think it's like an epidural that they've either had for labor or for some other type of procedure where they can't walk after they get it. This does not cause any motor weakness. So patients can get right out of bed immediately, which is really our goal. And Dr. Giersoli spoke about that. Earlier rehab, earlier ambulation leads to earlier discharge.
SPEAKER_03Now we'll meet Vince, who was suffering from terrible back pain that was robbing him of living a normal life. This new pain management approach during his recent surgery made it possible for him to recover without the use of narcotics, which was a big priority for him. What was happening with you?
SPEAKER_01Well, I had three surgeries before this, and I've had pain on all of them. Kind of the pain never went away. Because I was bent over walking all the time, and now I'm standing up straight. The pain is gone, so whatever they did, it worked.
SPEAKER_04How painful was that pain? Can you describe it?
SPEAKER_01It was 24-7. I was I was in pain. I'd say no less than a six or seven every day, all night long. It was really getting to me. I was taking it out on my wife at times because I just I just couldn't take it at times.
SPEAKER_04It's really no way to live, isn't it?
SPEAKER_01No, it wasn't, it wasn't any way to live. Uh I just I it it was just painful. And I just, I don't know, you know, when somebody's in pain constantly, it just wears you down.
SPEAKER_04Were you worried? I mean, I'm presuming you were prescribed pain medications.
SPEAKER_01Well, I kind of don't take it. I took Tylenol when I needed it, but uh that helped for a little while, but then it just, you know, I'll tolerate the pain before I take any pain medicine.
SPEAKER_04And why is that? Are you worried about getting addicted to anything?
SPEAKER_01Yeah, that that that was part of it, but my whole life was I never took any pain medicine. It was just, you know, if I took an aspirin, an advil, a Tylenol, that's all it, you know, it worked for a while. This time it worked for maybe an hour, and then that was it.
SPEAKER_04Wow. Okay, so your your surgery was in the morning, right?
SPEAKER_01It was first first one in the morning.
SPEAKER_04And when did you start walking without pain?
SPEAKER_01The very next day. I haven't had a bit of pain, not one bit of pain, since the operation.
unknownWow.
SPEAKER_01They told me that this pain blocker that they gave me would last three days, and that I was supposed to take the pain medicine to be free of pain. I never took one pain pill at all. I just it this this whatever it was, it worked, and I recommend it to anybody. It worked for me.
SPEAKER_04You said you were stupid like this. Describe that before.
SPEAKER_01Well, let me show you. This is the way I'd walk all the time. My wife was so upset over it. I could I couldn't sit for any period of time. I was just uh every time I walked, walked around, people thought I was an old old man. Since this, that rod they put in won't let me go down. It keeps me straight and no pain. That's all I can say. There's no pain to it.
SPEAKER_04So how has it impacted your life now?
SPEAKER_01Now? Well, I'm still still in therapy. I'm outpatient therapy, but uh it's worked out good. Even after therapy, there's no pain at all. I get up and I leave. The therapist says, good for you. He says he can't believe it either. There's no pain.
SPEAKER_04That's amazing, isn't it?
SPEAKER_01It is, it is.
SPEAKER_04I you know, I just go from such extreme pain to nothing.
SPEAKER_01That's that's just the way it went. That's just the way it went. There was there was days that I couldn't move out of the the the chair. It was just I just and sitting sitting in a chair like this, never, never happened. I sit there about 10 minutes and I had to get up. I just could I just couldn't sit around. And I couldn't walk. If I walked a hundred feet, that was the most. And that was it.
SPEAKER_04So now what are you doing? You're walking everywhere?
SPEAKER_01Now I'm walking, I'm probably walking a good quarter mile now with no pain at all. I walk in my complex where we live, and I have no pain at all. I walk every morning. Do my exercises every morning, and I had no problems.
SPEAKER_04What kind of exercises do you do?
SPEAKER_01It's all my leg exercises. Moving my legs different positions, doing squats, doing uh knee bends. It's just trying to build up my core body.
SPEAKER_04And you couldn't do any of that before.
SPEAKER_01I couldn't move. My wife used to go out by herself with her friends because I couldn't go with them. Oh so now hopefully in a short period of time, everything even worked better that I'll be able to go out with and spend a lot of time out there.
SPEAKER_04Okay, but it's getting there.
SPEAKER_01It's getting there.
SPEAKER_04Any hiccup at all uh this whole car tie?
SPEAKER_01There's nothing. I I mean, I mean, I I just saw Dr. Gerisoli uh everything looked great. He even saw it myself. He's happy with it, and I'm certainly happy with it.
SPEAKER_04That is so cool.
SPEAKER_01Yeah, it is. You you wouldn't believe it. Unless you have back pain, you don't know what it's like when you can't do anything.
SPEAKER_03If you or someone you love is living with back pain, there is a range of surgical and non-surgical options you need to explore. Visit St. Vincent's dot org slash spine to learn more. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.
SPEAKER_06I'm ready for my close up. All the faces start to light up. You know I love this feeling. I got more life in my life. If you feel it, then you know. We can go anywhere we want to go. We're gonna love this feeling. We got more life in my life. You know, I love this life.