Local doctor limiting opioid use after surgery

Dr. Kathleen Hogan uses a non-opioid option as part of her protocol to control pain after performing knee and hip replacement surgeries. Here, she shows orthopedic technician Kassandra Luz how a knee looks after replacement.

NASHUA – In some cases, people have developed opioid addictions by taking drugs such as fentanyl in an attempt to reduce pain after undergoing surgery.

In recognizing this potential risk and the side effects of pain medicines, Dr. Kathleen Hogan uses a non-opioid option called Exparel as part of her protocol to control pain after surgical procedures.

New Hampshire continues to combat the opioid crisis as one of the hardest hit areas of the country. While opioids have been considered the primary choice for pain management after surgeries, Hogan, of Windham, aims to treat her patients utilizing a multimodal pain management approach during orthopedic procedures, including hip and knee replacements.

“I’ve been a really early adapter to this whole idea of multimodal pain medicine where you try to treat the pain from multiple different ways to try to minimize the amount of narcotics that people get,” Hogan said.

“So, even before the whole opioid crisis came out, I was using anti-inflammatories.”

Hogan said the drug is injected during surgery and can minimize – or in some cases, eliminate – the need for opioids after surgery. As a result, her patients return home quicker, while requiring less opioids, and reporting less overall pain.

Hogan said many joint surgeons in Manchester and Nashua have adopted this practice.

“I think I’ve been using it for probably about two or three (years) now,” Hogan said of the drug. “It is something that we keep making progress, in terms of ways that we can control pain after surgery. Twenty years ago, when knee replacements were new, people would stay in the hospital for a week.”

She said during those early years of joint replacements, people would be put in casts after the surgery. Ten years ago when she started, she said people would stay in hospitals for three or four days, and that it would be the most painful surgery to undergo. However, she said this is now changing.

“Now, we’re at the point where most people go home the next day,” Hogan said. “We tell, people it hurts. The first couple weeks are the worst, but it’s probably no longer the most painful surgery that they’ll ever have because we can do these things.”

She said in some cases, patients will even be sent home the same day, but not everyone qualifies. A patient would have to be quite motivated and healthy to do that. In any event, Hogan said the biggest difference when using this non-opioid is pain control.

Hogan said through time, she has really begun to realize how well this medicine works – and going on mission trips has really helped to reinforce that realization. Aside from performing surgeries in New Hampshire, Hogan also extends a helping hand through her mission work with an all-female group of orthopedic surgeons called Women Orthopaedist Global Outreach. The team provides orthopedic surgeries to women in underserved communities around the world, and has introduced non-opioid options to countries such as the Republic of the Congo and Cuba, to name two. She and the WOGO crew also performed the first knee replacements in the Congo. Being involved with that first replacement was one of the most challenging things she has done.

She said these mission trips are something she is really passionate about, and is looking forward to their next one when they will be going to Bolivia.

“Only 5 percent of orthopedic surgeons are women, and only about 1 percent are fellowship trained joint replacement surgeons, so we’re like super small niche,” Hogan said. “It’s really cool that there’s seven of us all doing the same thing.”

Hogan said usually, people are on pain medication for two weeks afterward, but some may take them for a little longer. However, she said people are really using them for their physical therapy or to relieve discomfort at night.

“I’ve always believed that narcotics aren’t great for you,” Hogan said.

Adam Urquhart may be contacted at 594-1206, or at aurquhart@nashuatelegraph.com.