DeBari credits her positive experience in part to the type of implant used: a custom-fit knee replacement designed based on X-rays sent to the manufacturer and made to the specifications of her existing knee, so there was less trauma in adjusting to the hardware. But the major reason, she says, was the pain management during and after the procedure. She had entrusted her orthopedic surgeon, David A. Harwood, MD ’84, clinical associate professor of surgery at Robert Wood Johnson Medical School, with determining the best course for her particular procedure. He consulted with Geza Kiss, MD ’95, associate professor of anesthesiology and clinical director of acute pain and regional anesthesia for the medical school, and they decided to use regional anesthesia for the procedure. While local anesthetics numb only a small area of the body, and general anesthesia involves a total loss of consciousness and pain sensation, regional anesthesia is used to make a large area of the body insensate to painful stimuli, Dr. Kiss explains. It is achieved by injecting medication near a cluster of nerves to numb only the area that needs surgery, he adds. DeBari received a femoral and sciatic nerve block, as well as a sedative to allow her to “sleep” comfortably during the surgery; the anesthesia was delivered through a catheter that was kept in for two more days to provide optimal pain relief. The day after the catheter was removed, she was discharged from the hospital and entered a Lawrenceville-based rehabilitation facility, from which she was able to go home far sooner than anticipated because she was doing so well. She experienced similar positive results in her outpatient physical therapy, she says. “I did so well the therapists couldn’t believe it, and I honestly think it was because there was no pain involved,” DeBari says. “You are very hesitant in physical therapy when it hurts. I had no pain, so I was able to do all the exercises right from the beginning.” A widow who takes care of all the responsibilities around her home, she is now very active and walks approximately three to five miles per day, including a tremendous amount of walking at work. “Before the surgery, I said I want to get back to doing everything I could do before: I want to wear heels, I don’t want to walk with a limp, I don’t want to have to use a cane or a walker. I’m 70 years old, and I’m fine,” says DeBari, noting that her only issue is a little difficulty when she kneels on a hard surface to scrub the kitchen floor. “I pray that anyone else who has to have this surgery has the kind of experience I did. I have told everyone that if you ever have to have a knee replacement, you must go to Robert 8 Robert Wood Johnson I MEDICINE Wood Johnson, you must see Dr. Harwood, and you must have Dr. Kiss as your anesthesiologist,” she says. Controlling Pain increasing role of regional anesthesia techniques in pain management and patient satisfaction. Pain—now considered one of the vital signs—can adversely impact patients’ cardiovascular stress response, among other negative physical effects, if not properly controlled, says Scott J. Mellender, MD, assistant professor of anesthesiology at Robert Wood Johnson Medical School and clinical director of the New Jersey Pain Institute at Robert Wood Johnson University Hospital. “You have a moral and ethical responsibility to control your patients’ pain, but you also want them to have a good level of satisfaction with their care,” he adds. The medical school’s Department of Anesthesiology has been working to dramatically improve pain management and the patient’s experience, in and out of the operating room, says Christine H. Fratzola, MD, associate professor and chair, Department of Anesthesiology. Many of those advances are taking place in the area of regional anesthesia, in which the department has specialists with a high level of skill and expertise, including the use of newer methods of ultrasound guidance and advanced, minimally invasive procedures for chronic pain, Dr. Fratzola says. Today, regional anesthesia encompasses spinal and epidural anesthesia, as well as peripheral nerve blocks. It is frequently used for certain orthopedic, gynecologic, obstetric, and ophthalmologic surgeries. And it typically results in reduced side effects, including less post-operative pain, less nausea, lower incidence of blood clots, less blood loss, less of a stress response by the body, and earlier mobility. For same-day surgeries, regional anesthesia can provide 18 to 24 hours of significant pain relief without narcotics, Dr. Kiss says. For some procedures, a single injection of long-acting anesthetic is all that is needed. With others— such as DeBari’s knee replacement—a catheter is inserted to allow the anesthetic to be delivered over a period of two to three days, he adds. d eBari’s experience epitomizes the impact of effective pain control in recovery, as well as the Evolving Techniques d espite the benefits, patients sometimes are concerned about the concept of being awake during surgery, afraid of hearing or otherwise being aware of what is going on, Dr. Kiss says. Different levels of seda-