Damage from Iovera Nerve block prior to TKR

Posted by kathi65 @kathi65, Nov 8, 2022

I had right TKR 18 weeks ago. Prior to surgery I had lower leg neuropathy and a neurologist could not determine why after testing (you're part of the 20% of the population that gets it for an unknown reason she said). My surgeon recommended the Iovera nerve block prior to surgery because it would help with pain after the surgery. He said that the nerve block would last for about 3 months. I had no problem when the injection was done, minimal bruising and my leg was numb. It's now been more than 3 months later and I still have numbness going all the way down the inside of my thigh to my knee and when I touched the skin it feels like someone's taking a razor blade and slicing my skin open. I'm also having problems when I bend my leg in certain ways or touch my leg in certain spots I start get sharp nerve pains down on my lower leg. I don't know if this is from the Iovera injection or not. And I have a feeling nobody's really going to tell me. Has this happened to anybody else? I already had a chronic pain condition before surgery and if I had known that I would feel the way I do now I don't think I would have had my knee replaced!

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steve8899 | @steve8899 | Sep 17 10:05am

In reply to @catheem "Thank you! Also, can you tell me where you see the negative outcomes? Do you have..." + (show)

I had TKR Feb 19. When the nerve block wore off the next day, i had unbearable pain when I stood up. As the blood ran into my leg as I stood up, it was immediately on FIRE. The worst lasted for more than 2 weeks, no sleep during that time. Doctors staff was totally incompetent with the pain meds. Could not do the physical therapy due to pain. I was told by an anesthesiologist and a physical therapist that i must have nerve damage. By the time i was able to do physical therapy, I had already built up enough scar tissue that i could not bend past 90 degrees no matter how hard i tried. Doctor said he had to go in and remove scar tissue with an arthroscopic procedure. He said i should have the Iovera before the procedure. I trusted him and did no homework. Had Iovera May 10, surgery on May 22. Iovera procedure was very uncomfortable. He hit the nerve a couple times resulting in electrical shock like pain. Knee was totally numb after with some pain and swelling at the injection sites with a large knot in my quad just above the knee. Arthroscopic surgery went well, 135 degrees flex within a few days with minimal pain. He had me on 10 mg oxy for 10 days after the procedure. I am over 4 months from the Iovera, and still very numb. Occasionally i get a stabbing pain in the knee and sometimes in the foot.?? I think being able to feel what is going on in the knee would help in the recovery. I am having a difficult time strengthening the leg. Walking up steps is difficult. Before the TKR surgery, i had no trouble with strength, only pain. I feel like the Iovera has hindered my recovery. It could be that the PA did not do the procedure properly since i was told that the numbness would last up to 90 days. If I knew then what I know now, I would never have done the Iovera. Avoid it if you can.

catheem | @catheem | Sep 17 11:05am

In reply to @steve8899 "I had TKR Feb 19. When the nerve block wore off the next day, i had..." + (show)

I'm sorry to hear this! I actually cancelled my TKR that was scheduled for 9/10. I started doing my own exercises daily/and cortisone/red light therapy, etc. Yes, I realize that is just a 'bandaid,' but so hoping that new things will come up that will make the recovery of TKR a bit easier! I hope you get through this with as little discomfort as possible! I was hoping that Iovera would work when I do have a TKR, but have to consider the good/bad of it! Thanks and good luck to you!

maljazur | @maljazur | Oct 18 12:39pm

In reply to @catheem "Please let us know how you do with the injection! Mine isn't scheduled until September, when..." + (show)

I'm so sorry I failed to reply before as promised. I had the Iovera treatment Judy before my TKR in June. Although recovery was painful, I have to credit the Iovera (and a plant-based diet and strict adherence to my exercises) with my rapid recovery. Since I don't have anything to compare it to, like those getting a second surgery, it's hard to tell, but everyone remarked how fast I was recovering. Now, 4 months post-surgery, I'm walking 10k steps most days, parking wherever I'd like :), and going up and down stairs with almost no problem.
I do still have some numbness around my knee, but it's mostly "weird" and no problem. My knee still gets stiff regularly, but massage or exercise takes care of it.
All in all, if I ever have to do it again, I'd opt for Iovera again. I don't even want to know what it would be like without it! I hope your surgery went well and you are recovering nicely.

lindielulu | @lindielulu | Oct 20 3:19pm

In reply to @meiwai "Thank you for the positive encouragement. In regard to doing research and your homework, what I..." + (show)

@meiwai

Thank you for the positive encouragement. In regard to doing research and your homework, what I recommend is to definitely watch a video about how the procedure is performed. How a needle is used to poke under the skin in the upper thigh area to numb about 3 inches in length across the thigh...this is very painful as the skin tissue and muscle in that area is tender and soft. Then the IOVERA three-pronged needle is used to poke again across the same thigh area. This is also done in the inside area of the knees...also very painful even with numbing. Look at a chart showing the different nerves around the knees and be aware which ones will be numbed. Know that the numbing sensation will be felt all over on the outside of your body and not just on the nerves on the inside. Tingling and itching occurs when the numbing begins to wear off and can also move to different areas on your leg such as the lower leg and ankle. I never really experienced much nerve pain prior to having the IOVERA but now I feel sharp, stabbing, burning pain inside my legs. In my opinion this procedure is harsh and a very invasive procedure. Really consider why you are wanting to have it done and if there are any other options. I can attest that the procedure alone causes much more pain than the end result...which provided no pain relief to my knees and legs at all. I do not recall the person using an ultrasound device during the procedure. Please also note that the cost of this treatment was not covered under my health insurance and was very costly. I'm still trying to stay positive about my experience but beginning to feel regretful. Icing, elevation, rest and care does not appear to be helping so I have resorted to taking a round of prednisone which seems to be helping with the inflammation, pain and healing. Thank you for your comments, replies and concern. Thank you for listening and sharing...sending warm hugs and healing to you.

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@meiwai I could have written your post, I am sorry you are had these problems and it has been a month since I had this procedure. I wound up cancelling my knee replacement 1 day after the procedure due to new information my doctor didn't tell me about. My insurance paid for the Iovera ($800) and I would gladly pay the $800 to get my leg back in the shape it was before I had it. I don't have any swelling but the pain is awful. It feels like I was hit with a baseball bat in my thigh along with burning, itching, needles. I can't imagine having all this pain on top of the surgical pain. To top it off, the doctor that performed the procedure has been unreachable due to "major family emergency" and they have no one to advise me. I would never do this again, it is pure misery. I notice you had yours done in July, is it any better now? I am so afraid I am stuck with this awful pain. The knee itself was never affected, so I still have the knee pain along with this added pain from the Iovera. It sure wasn't a good experience for me. I asked the nurse before I got it if there were any downsides to it and she just said they had mixed results but no downsides. In other words, not everyone got the pain relief but I sure wasn't expecting more pain than I had in the first place.

catheem | @catheem | Oct 21 3:50pm

In reply to @maljazur "I'm so sorry I failed to reply before as promised. I had the Iovera treatment Judy..." + (show)

I'm so glad to hear about your surgery and how well you have been! I actually cancelled my surgery that was scheduled in September! I started doing everything I could to build up my muscles around the knee/stopped carbs/and started stretching 2 times a day! So far, so good! I am not bone on bone, and my injury was a torn meniscus that led to osteoarthritis of the kneecap. I have no idea how the particular things I am doing is helping me so much...

lindielulu | @lindielulu | Oct 23 7:38am

In reply to @catheem "I'm sorry to hear this! I actually cancelled my TKR that was scheduled for 9/10. I..." + (show)

I"m with you on that. I have been watching videos on youtube (mixed blessing) but one thing I have been doing is exercising the glute muscles. I can do 10 reps before I get out of bed in the morning and that eases and sometimes eliminates my knee pain for a while. I too am waiting for new developments in TKR and for me, it is not Iovera. Cortisone also does nothing for me but I have heard quite a bit about red light therapy, I will look into that more.

hemjem | @hemjem | Nov 1 2:02pm

In reply to @jmos "18 months after Iovera and TKR…. Numbness, vice like constriction all around knee, pins and needles..." + (show)

I had Iovera Treatment 3 weeks prior to TKR on right knee. The treatment was extremely painful to say the least.
It is now 2 1/2 months since my surgery.
Just like yours, much of the numbness has worn off EXCEPT for the kneecap & right around it. Which is also vice-like constriction or extreme tightness. Apparently the nerves in this area do NOT want to wake up.
So am experiencing a lot of pain. I went day after sugery to rehab facility for 10 days. Then had 3 weeks of home p.t. The dr released me to drive 3 weeks post surgery. I have now completed 4 weeks of intense 3 x weekly out patient p.t.
Beginning to wonder when this pain will let up!

kobesnowy | @kobesnowy | Nov 3 3:43am

I am over 4 months out and have the same issue. I cancelled the surgery
The arrogant PA told me to let him do it over or suffer three months
It’s over 4 and I don’t know what to d…besides having the same issues as you the area is also hard as a rock

I screamed on the table from the horrible pain too

There is no help around so I say stay away from it

hemjem | @hemjem | Nov 4 9:59am

In reply to @kobesnowy "I am over 4 months out and have the same issue. I cancelled the surgery The..." + (show)

I re-read your message. So please confirm, you did NOT have the knee replacement surgery?
The Iovera is meant to last a minimum of 3 months. However, I have talked to several people that said theirs lasted quite a bit longer.
The feeling of a 'wooden leg' after the treatment is designed to sharply minimize the pain you would have felt right after surgery (if you had not had the Iovera) & also thru the painful rehab process.
I still have extreme tightness (like a tourniquet or band) around my knee cap.
Await your reply!

kobesnowy | @kobesnowy | Nov 4 12:50pm

In reply to @hemjem "I re-read your message. So please confirm, you did NOT have the knee replacement surgery? The..." + (show)