Non Narcotics Surgery

Teresa Jensen, 54, was the first person to have a total joint replacement without the use of narcotics at the Cumberland Valley Surgery Center in Hagerstown.


Teresa Jensen, 54, was always an avid runner.

She completed the JFK 50 Mile race four times and always tried to stay fit and healthy.

When Jensen found out that she had to have a total knee replacement, the last thing she wanted was to be off her feet for too long.


Her doctor said she was the perfect candidate for a new program being launched at Cumberland Valley Surgery Center in Hagerstown. It would allow her to go home the same day of her surgery.

“I was really excited about it because you heal Ok in the hospital, but I think you heal better when you’re home,” said Jensen, who lives in Charles Town, West Virginia, and works as a deputy clerk in land records at the Circuit Court for Washington County.

The new program is the first total joint replacement surgery for the center in which doctors and anesthesiologists would not use narcotics.

“For people who are not sick, the best thing to stay well is to stay out of hospital,” said Dr. Thomas Amalfitano, a surgeon with the Centers for Advanced Orthopaedics in Hagerstown. “Focusing on procedures using these modern techniques that helps patients go home from surgery the same day will reduce the risk of complications from infection and allow hospitals to spend more time on the sickest patients."

Plans for the new surgery procedure started in November. Jensen had her surgery at the end of April.

“What we really wanted to do for the program is we didn’t want to bring them in and release them,” said Amy Sachs, administrator at Cumberland Valley Surgery Center. “We wanted a best practices program that included the physician and made the patient feel like they were getting continuity of care."

The outpatient total joint procedure program is a collaborative effort between several doctors, anesthesiologists, physical therapists, nurses and other medical professionals.

“One of the things that makes this different is there is usually a lot of silence,” said Dr. Eric Shepard, the Maryland director of regional anesthesia for Safe Sedation. “We’ve changed that entirely, where all of the doctors and medical professionals on the case are talking to each other and planning out the care of the patient well before they come in for surgery and well after."

One unique aspect of the surgery is a “numbing pump” used to keep patients comfortable when they come home from the surgery center. For Jensen, a pump was inserted through a catheter into the top of the knee. A slow drip of numbing medicine was continuously released for three days following her surgery.

There’s a button on the pump that she could push to release more numbing medicine if she got uncomfortable.

But the miraculous aspect of the surgery to Jensen and her medical team was the fact that she went home a few hours after the surgery and walked up her stairs to bed the same day.


“I couldn’t believe that I was able to make my way up the stairs without excruciating pain,” Jensen said.

Throughout the entire healing process, Jensen has only taken Tylenol. She was prescribed narcotics as a safety backup measure, but said she hasn’t touched them.

A physical therapist has visited her every day since she went home. The plan includes an in-home physical therapist once a day, for five days a week, for two weeks. After that, Jensen will visit a physical therapy clinic.

The goal of the procedure isn’t to be pain-free, but to be educated about the healing process along the way.

“We go into the patient’s home a month before the surgery with the rehabs’ role,” said John Baker, president of Baker Rehab Group. “We sit down with them and work to prepare them mentally. We talk about pain and how it’s not about being pain-free, but more about pain management."

The surgery center plans to use the success of this surgery and expand the program to shoulder and hip surgeries.

In addition, by not using narcotics for the surgery, doctors are hoping this has an impact on the ease of recovery and addiction.

“While most people who take small amounts of opioids don’t become addicted, most people who are addicted were introduced through post-operative opioids,” Shepard said. “They end up with more pain afterwards and need more opioids. By eliminating the use completely, I think that we will have a significant impact on the use of opioids in the area."