Nerve block during TKR - pro and con?
I had TKR of my right knee this past February and I'm having my left knee done this Thursday. I am on blood thinners due to a history of PEs. The morning of my first TKR, the anesthesiologist opted not to do a nerve block because I had been instructed to stop the blood thinner 2 days prior to surgery and he would have been more comfortable had it been 3. I think I was fine without the nerve block – I was up and moving as directed on a walker the day of the surgery and pain was well controlled with oral medications.
This time around, I've been instructed to stop the blood thinner 3 days prior to allow for the nerve block. However, I have heard some bad things about nerve blocks (specifically, long term numbness in the leg that never completely goes away) so I am a little concerned. I'm wondering what advice / feedback the forum might have to offer.
Thanks in advance.
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By nerve block are you referring to a spinal or epidural? I am on blood thinners and was advised to stop taking Xarelto three days prior to surgery which made me very nervous. It all went well but it was a tricky situation.
I had nerve block done with TKR in January. Told to stop taking blood thinner week in advance. Anesthesiologist recommended nerve block and it went very we with no complicating factors. Will do it again when I’m called for second surgery.
I am replying to your question about nerve blocks. I, too, was on Coumadin for blood thinners and I followed all the directions for stopping this before TKR. I was advised to get nerve blocks before the procedure, consisting of very very cold water injected into the nerve areas of the knee to numb it prior to the procedure. I don’t remember the name of this nerve block, but I will check in again when I do.
Long story short, I ended up with a DVT and a hematoma and a leg all colors of the rainbow, and numbness throughout my lower leg from nerve damage. The doctors (separate ones) privately advised my wife that they were struggling to save my leg. I had to go to a different hospital to get treated at this point. I don’t know that I can attribute these problems to the injecting of this nerve block, but I was in a hospital and/or nursing home for 4 months and I still have a very nerve damaged leg from what I suspect was the nerve block. This is 4 years on from my TKR. (Got it! Iovera, which is a brand name) Because of my disaster I would advise you to forego any nerve blocking prior to TKR.
See my experience with the nerve block Iovera, below. My experience was like yours in that I also have a history of PE’s. I strongly advise not to have any nerve block.
I had double knee surgery in Feb this year . The anesthesiologist administered a nerve block in each of my thighs. I was told it would reduce my pain after my partial knee surgery (inside joint of each knee was replaced). I had no feelings in my legs for almost 3 weeks after the surgery from the knee to the ankle. I still have areas which are numb. I also had a lot of swelling. I'm now 13 weeks post surgery and can only bend about 45 degrees for my right, and about 70 degrees for my left. It has been a very frustrating time. Right after the surgery I couldn't discern a cold pack from a heating pad. I have been doing all home exercises, going to physio and even wearing the Dynasplints to hopefully break up or release scar tissue.
Knowing and feeling what I've been through, my vote is a hard NO to nerve blocks.
Yes Iovera is brand i had as well on January 3, 2023. Right lower Part of my knee is still numb. I was told it takes awhile for the nerves to repair. No other complications, but i hesitate to use the Iovea on next surgery. I felt it was more superficial pain relief of the skin. Can’t feel when trying to shave my leg in that area. Very weird.
@linnie1948 – the surgeon didn't tell me which kind of nerve block would be used.
I’ve come to realize that a nerve block is not a spinal. I had an injection in my spine for the hip replacement.
How is the dynasplint working for you? Does it nake your knee hurt more? Its slow it seems.
I had TKR on my right knee about 11 months ago. My surgeon used a nerve block and it was an enormous help to me those first 24 hours. It allowed me to get up and walk the same day of surgery, which is very important to recovery of the knee. I have had some numbness in the area near the incision, and in my toes. However, when you consider that the surgeon has to cut open your knee, and work around your muscles, nerves, and tendons, it is logical those things take time to heal and recover. My knee joint was severely damaged, which caused me to be knock-kneed. As a result, the surgeon had to straighten my leg by shaving some of the bone. This required him to move the nerves around my knee and there was a risk of paralysis. Thankfully the paralysis did not occur, but I have always believed that the reason for the numbness in my knee and toes is attributed to moving the nerves, not to the nerve block. It sounds like your experience was different than mine. But I wonder if the surgery itself, instead of the nerve block, could be part of the reason for the numbness you feel.