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Insomnia after THR with spinal anesthesia & propofol

Posted by sleepless1 @sleepless1, May 2, 2022

I am 6 weeks out after THR with spinal anesthesia and propofol, a single dose of ketamine was also given. I have not used any narcotics or NSAIDS before or after surgery, only Tylenol and ice packs with good results. I do not have pain nor did I have any immediately post-op. Surgical outcome seems great BUT I have not been able to sleep more than about 2 hours at a time. After that, I am wide awake and feel like I just woke up after the propofol. I have had propofol 3 times previously for colonoscopies and meniscus surgery and had no issues. I am wondering if this is a dose-related phenomenon.
I tried melatonin and the only result was an AM hangover that lasted a couple of hours. I have researched this issue, and it appears to be a common side effect of this procedure and total knee replacement as well. There is very little info about sleep disturbance after anesthesia or what to do. It appears that anesthesiologists or CRNAs do not follow up for outpatient THA except the day after surgery - that to me seems inadequate for the healthcare professionals that administer these drugs. I found one study out of Austria stating that sleep improves after 10 months in 60% of patients - wonder what the other 40% are up to… Does anyone have experience and overcome this problem? I do not want to start Benadryl or benzodiazepines. Thanks

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Mentor
John, Volunteer Mentor | @johnbishop | May 2, 2022

Hello @sleepless1, Welcome to Connect. I know it can be a struggle sleeping after a hip replacement or any major surgery if you are still having pain but it sounds like your recovery has been OK other than not being able to get back to sleeping normally. I had some trouble sleeping early on after my knee replacement but it was more due to not being comfortable as I also didn't have much pain after my TKR. You mentioned you have done a lot of searching and have not found anything that has helped. @sueinmn, @artscaping and others who have had hip replacements may have some thoughts or suggestions to share with you.

Here is some information from 2017 I found that talks about the topic but I'm not sure how helpful it is.
-- Improve postoperative sleep: what can we do?: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768217/

Another search engine I use when looking for the latest medical research information is Google Scholar. It has some easy to use sorting of search results by year -- https://scholar.google.com/

Has your doctor or surgeon offered any suggestions to help with the insomnia?

REPLY
1 reply
sleepless1 | @sleepless1 | May 2, 2022
In reply to @johnbishop "Hello @sleepless1, Welcome to Connect. I know it can be a struggle sleeping after a hip..." + (show)
@johnbishop

Hello @sleepless1, Welcome to Connect. I know it can be a struggle sleeping after a hip replacement or any major surgery if you are still having pain but it sounds like your recovery has been OK other than not being able to get back to sleeping normally. I had some trouble sleeping early on after my knee replacement but it was more due to not being comfortable as I also didn't have much pain after my TKR. You mentioned you have done a lot of searching and have not found anything that has helped. @sueinmn, @artscaping and others who have had hip replacements may have some thoughts or suggestions to share with you.

Here is some information from 2017 I found that talks about the topic but I'm not sure how helpful it is.
-- Improve postoperative sleep: what can we do?: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768217/

Another search engine I use when looking for the latest medical research information is Google Scholar. It has some easy to use sorting of search results by year -- https://scholar.google.com/

Has your doctor or surgeon offered any suggestions to help with the insomnia?

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Thanks for the info and links - pain had not an issue at any point, pre or post op and must articles are based on pain disrupting sleep. This is not the case. I know knees can be pretty painful, but hips generally no so. I suspect that the REM pattern was changed and it is roughly the time of propofol infusion so I am wondering if there is a possible link to either dose or length of exposure. Meeting with surgeon for 6 week post op and we will certainly talk about this and the decrease in quality of life that is brings. Thanks again for your input

REPLY
1 reply
Moderator
Colleen Young, Connect Director | @colleenyoung | May 13, 2022
In reply to @sleepless1 "Thanks for the info and links - pain had not an issue at any point, pre..." + (show)
@sleepless1

Thanks for the info and links - pain had not an issue at any point, pre or post op and must articles are based on pain disrupting sleep. This is not the case. I know knees can be pretty painful, but hips generally no so. I suspect that the REM pattern was changed and it is roughly the time of propofol infusion so I am wondering if there is a possible link to either dose or length of exposure. Meeting with surgeon for 6 week post op and we will certainly talk about this and the decrease in quality of life that is brings. Thanks again for your input

Jump to this post

I'm curious. @sleepless1, did you learn anything at your followup with your surgeon? How is your sleep these days?

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