Andrew Kuntz, MD, Talks Perioperative Pain Management for Shoulder and Elbow Procedures

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Shoulder and Elbow Image

Penn Medicine is advancing innovative approaches to shoulder and elbow treatment, and to shoulder and elbow surgery, by providing a full continuum of care before, during, and after surgery. Working as a collaborative team across specialties, Penn has optimized every stage of the process -- from patient education to reducing post-op shoulder and elbow pain without the use of narcotics.

A Comprehensive Continuum of Care for Shoulder and Elbow Injuries

“We have a number of things that make our division exceptional” said Andrew Kuntz, MD, Director, Shoulder Study Group, Penn Medicine. “But what we think makes Penn Orthopaedics genuinely unique is our comprehensive approach to treating our patients.”

“Penn’s orthopaedic surgeons don’t spend all their time in the OR,” Dr. Kuntz said, illustrating the point. “They see their patients from the initial shoulder or elbow injury evaluation straight through to recovery, and are involved in all aspects of patient care.”

Diagnosis and Treatment: All Under One Roof

“At most Penn locations,” Dr. Kuntz continued, “we offer comprehensive orthopaedic centers staffed by a wide range of medical professionals, so that patients can receive their perioperative care under one roof.”

Not only are patients seen and evaluated by a Penn orthopaedic specialist at these locations, but they have access to lab facilities and onsite diagnostic professionals. This includes dedicated musculoskeletal radiology technicians using state-of-the-art imaging to provide the most accurate diagnosis and treatment plans.

To ensure a continuum of care for all patients, the Penn Shoulder and Elbow Treatment Program offers access to a spectrum of specialists and services in the same facility.

“This includes our medicine colleagues, our cardiologists, our anesthesiologists and pain providers, and our rheumatologists,” Dr. Kuntz explained. “So, for any different medical condition or aspect of their care, patients can be seen in the same location and receive care right in one spot.”

Penn Shoulder and Elbow Tackles Postoperative Pain Relief

Postoperative pain is the number one worry for many patients following shoulder and elbow surgery.

With opioid abuse now at pandemic levels in the United States, Dr. Kuntz and his colleagues wanted to develop a research-based pain protocol that could make patients more comfortable with fewer narcotics.

“This is a protocol we started developing a number of years ago and the goal really was to improve the patient experience following shoulder surgery,” Dr. Kuntz said. “Recovery from shoulder surgery can be prolonged and painful, and we wanted to make that more tolerable for our patients.”

Dr. Kuntz and his orthopaedic colleagues worked alongside anesthesiologists and pain management specialists to develop a unique pain protocol that would address postoperative pain from many different therapeutic angles, with the goal of reducing pain, improving recovery, and reducing the number of narcotics the patient needed.

"Typically, patients in the community who undergo surgery are prescribed opioids and other narcotic medications to manage postoperative pain," Dr. Kuntz said. "What makes this pain protocol a win-win is that we are prescribing far fewer narcotics, and patients are reporting far better pain management and far happier recoveries from surgery."

Realizing that the most effective pain management can start even before surgery begins, patients at Penn are given non-narcotic pain medications before and during their surgery to help head off the development of pain during recovery. After surgery, patients can then be given simple medications like Tylenol, anti-inflammatories, and medications for nerve pain, as well as peripheral nerve blocks.

“We are using a lot of non-narcotic medications again, before, during and after surgery to manage pain and then reduce the amount of narcotics patients are receiving,” Dr. Kuntz explained.

A Research-Based Pain Protocol

The pain protocol was developed through a multidisciplinary approach anchored by meticulous attention to published research.

“It’s based on a lot of basic science and clinical research looking to make sure that the medications we’re using help alleviate pain but don’t negatively impact the healing process,” Dr. Kuntz said.

A particular challenge was coming up with a perioperative pain protocol that could work universally for all patients. By working with pain management physicians and anesthesiologists, Dr. Kuntz was able to form a consensus around the best medications to use across the board.

Once the group of medications was settled on, Dr. Kuntz and his team trained providers on the newly developed pain protocol, from OR staff to pre- and post-operative providers, to ensure that patients receive the right pain medications at every step of the process.

Since Penn’s pain protocol for orthopaedic surgery is relatively new and unique, there is an emphasis on patient education to ensure patients are well informed, and that their expectations are realistic. “We educate patients ahead of surgery to talk about our pain protocol, the overall experience, and the fact that pain is a normal process of recovery,” Dr. Kuntz said. “But with these different medications; we can minimize that pain and make it a much more tolerable process.”

He added that it’s crucial to make sure patients know that the use of multiple medications, rather than a single narcotic, is necessary to make sure their recovery is as pain-free as possible.

On the Horizon

Currently, Dr. Kuntz is in the process of rolling out his innovative pain protocol to multiple sites across Penn, so that it will soon be available no matter where a patient initiates care. He is also looking at refining the medications being used, such as longer-lasting nerve blocks so that patients have more effective pain control.

“What we really want people to know is that we are here to take care of patients,” Dr. Kuntz added. “We are here to take care of our referrers’ patients and we see anything and everything shoulder and elbow.”

“There is not anything that we can’t take care of,” he continued. “We want to be easy to access and provide excellent care to anybody that comes through our doors.” 

 

Dr Kuntz recently recorded a podcast about the continuum of care at Penn Orthopaedics.

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The Penn Physician Blog is a resource for health care professionals featuring Penn Medicine physicians and their research, innovations, programs and events. 

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