Ten days after undergoing total knee replacement surgery, an Anchorage woman was referred to Dr. Luke Liu, an Alaska Regional anesthesiologist and pain management specialist, when her postoperative discomfort remained unmanageable. Known for his non-narcotic, revolutionary pain management procedure called the “Alaska Block,” Liu and the patient's surgeon believed that this procedure might be the solution for beginning to restore her quality of life.
Despite a robust regimen of pain medication, even after 10 days her pain continued to prevent her from being able to sleep and from participating in physical therapy”a critical component of recovery. Within 15 minutes of administering the block, though, Liu took a video of her noticeable turnaround. “I can dance toward you,” she says excitedly, as she moves toward the camera with little hesitation.
This is one of countless examples of feedback from more than 60 patients who have received the Alaska Block and report getting the quality of life back they had before surgery. “This is the holy grail of pain control for total knee replacement surgery,” Liu says. “With this procedure, we block the nerve without weakening the muscle so the patient can walk without debilitating knee pain and leg weakness.”
Leading the Way in Recovery
Alaska Regional is the first and only healthcare facility in the state offering this revolutionary nerve block procedure as part of its advanced total knee recovery program.Total knee surgery is a procedure known for having one of the most painful recoveries of any operation. Liu modified and improved the conventional blocking procedure, which he jokingly says he thought of naming the “Alaska Flamingo Block,” as a descriptive for patients who are able to steadily stand on one leg shortly after the placement of the nerve block.
Liu selectively blocks the sensory portion of the femoral nerve, leaving the patient's quadriceps muscle strength intact. This allows total knee surgery patients to move and maintain leg strength immediately after surgery, enabling them to walk without the debilitating knee pain and leg weakness that is so common after total knee surgery. “This is what sets the procedure apart from more traditional pain blocking techniques,” he says. For patients, it means faster recovery, shorter hospital stays and reduced risk of developing addiction, respiratory failure, blood clots, and other complications.
When 73-year-old Richard Ames had his left knee replaced in 2008, he experienced what he calls “super pain” after the surgery, despite traditional regimen of narcotics that kept him in a drug-induced fog and practically immobile. When he had the same surgery on his right knee this year, the recovery was measurably easier, which he attributes to Liu's block. The day after surgery, Ames was walking with a walker, after two weeks he replaced that with a cane and was experiencing only occasional minor pain, requiring minimum pain prescriptions.
How the Alaska Block Work
Technically referred to as the “distal femoral nerve catheter analgesia,” this non-narcotic pain management method has been used at Alaska Regional for more than a year. It provides pain relief to the knee area through a catheter pump system, and for most patients the numbing effect lasts three to four days after knee surgery, before the catheter is removed. For patients needing extended pain relief, it has been left in for as long as seven days. At Alaska Regional, it is measurably improving post-operative physical therapy success by reducing the patient's fear of moving, and reducing unwanted side effects related to conventional painkillers such as nausea, hallucinations, delirium, respiratory depression, addiction, dizziness and imbalance.
The Alaska Block is inserted by the anesthesiologist in conjunction with the surgical procedure. The portable pump is clipped to the patient's clothing or placed in a wearable carrying case and delivers a continuous infusion of local anesthetic through a specially designed catheter inserted next to the nerves supplying sensation to the surgical site. By delivering a slow, steady flow of local anesthetic directly to the source of pain, the Alaska Block provides patients with several days of targeted relief. Because it reduces the reliance on narcotics for pain relief, it reduces many narcotic-related side effects, and helps patients recover faster after surgery and with less pain. Patients go home about one day sooner, report up to 69 percent lower pain scores, and are more likely to be satisfied with their surgical outcome.
Setting Standards in Advanced Medicine
Peripheral nerve catheter analgesia is used in hospitals nationwide as an alternative to narcotics for post-operative pain control after orthopedic surgeries and may also be used to treat patients in a wide range of surgical specialties, including cardiovascular, OB/GYN and general surgery. What makes the “Alaska Flamingo Block” different from the traditional treatment prescribed after total knee replacement is that patients maintain full leg strength. “Historically, the traditional approach to pain management results in significant quadriceps weakness and patients are more likely to fall, predisposing them to sustaining additional injuries and preventing participation in physical therapy,” Liu says.
Gary Jensen was the first Alaska Regional patient to receive the nerve catheter in 2013 when he had his left knee replaced. He had such an easy recovery resulting from the block that he and Liu joked that the procedure should be named the “Liu-Jensen” or the “Jen Liu.” Although Jensen had heard the recovery horror stories, Jensen says he had no pain for the entire time the pain block was in and immediately after the surgery was able to walk and go up and down steps. “The nurses wanted to know my pain level and when I said zero, they looked at me like I was crazy.”