I know I need a hip replacement but I just don't know if I can face any more pain than I already have. I understand those first few days after the surgery can be brutal. Am I right?

Patients report a much smoother ride these days following total hip replacements. Pain control begins in the operating and recovery rooms. This is called perioperative management. Improved analgesic and anesthetic protocols have changed the way this surgery is done.

For example, patients receive antiinflammatory and sustained-release opioid (pain) medications before the operation. Some surgeons use an indwelling catheter (tube) into the hip area to deliver a local anesthetic (numbing agent). This is kept in place for the first two nights after surgery.

After the operation, a combination of medications may be used to control pain, improve function, and restore natural sleep. These include acetaminophen, a nonsteroidal antiinflammatory, and the sustained-release opioid. A short-acting opioid may be added for any break-through pain.

Doctors have found that if pain can be controlled from the beginning, patients do much better. It's possible to avoid the pain-spasm cycle that prevents movement and function. Patients are no longer encouraged to tough it out. Less pain means more function and a faster recovery.