Wondering about anesthesia and pain control post TKR

Posted by lblazina @lblazina, Sun, Apr 14 3:42pm

Planning to have TKR early June. OS says he will use nerve block with spinal anesthesia although I have spondyloloithesis, lumbar facet syndrome, intermittent sciatic pain and am terrified of spinal injections. Also, he says the nerve block will provide pain relief for first day but I am not sure about what types of oral pain meds any of you had post op. I understand a lot of docs don’t want to prescribe opiates? I appreciate your opinions. Thanks.

Depends a lot on the physician, as well as the interaction/previous history you had with your OS. I had 4 different surgeries within 9 years by the same OS, and he has always been more than generous in prescribing opioids. Probably because I always turned in at least 1/3 of the initial prescription because I did not need / chose to use it. I think the current opioid panic is overrated, and overstated. To people who are in legitimate post surgical pain there really is no substitute. Those who say ibuprofen works just as well are nuts. It does not. I would have the talk with the surgeon way in advance to know what you can expect. Opioids are a blessing, but they made me sluggish, and very constipated, and kept me from driving (and a good glass of wine with my steak).
I chose to tough it out after the first 7 days or so at home, switched to Tylenol (only thing permitted bc. of aspirin regimen, and totally useless), then went to Aleve. Initially 2/day, then 1, by week 4 pretty much ice, for the most part. However, that seems to be on the very low side as far what most people use.

Hi @lblazina, welcome to Connect. I am 9 days post op for total knee replacement for my right knee. I also was a little worried about the spinal tap and the nerve block since I have idiopathic small fiber peripheral neuropathy in both legs but I only have numbness and no pain. My doctor prescribed oxycodone 5 mg immediate release tablets (qty 15) for every 4 hours as needed for pain when the Tylenol 625 mg doesn't help enough. I've been taking Tylenol every 6 hours and it seems to be doing the job for me. I haven't had to take any of the oxycodone tablets. I would have a discussion with your doctor or surgeon about your concerns. My care team did a great job explaining all of the details and possible side effects with me to help alleviate some of the fears I had. I know there is always some risk in surgery but hopefully it's minimal.

I can tell you the second day was the hardest for me which I think is when the nerve block wears off. I still didn't have the piercing pain I was expecting but it was more an ache and soreness. Also the leg still looks like a watermelon so I'm hoping the swelling goes down this next week. I had surgery on the same knee back in the 70s to remove some torn cartilage and they gave me a spinal tap then too. The anesthesiologist really scared me when he came in and made me sign a release in case something went wrong with the spinal tap. I had second thoughts about the surgery but it was quite a treat for me to watch the surgery in the glass cabinets at the side of the room even though they had a sheet blocking my view of the surgeon and his team.

What is your biggest fear?

@ellerbracke

Depends a lot on the physician, as well as the interaction/previous history you had with your OS. I had 4 different surgeries within 9 years by the same OS, and he has always been more than generous in prescribing opioids. Probably because I always turned in at least 1/3 of the initial prescription because I did not need / chose to use it. I think the current opioid panic is overrated, and overstated. To people who are in legitimate post surgical pain there really is no substitute. Those who say ibuprofen works just as well are nuts. It does not. I would have the talk with the surgeon way in advance to know what you can expect. Opioids are a blessing, but they made me sluggish, and very constipated, and kept me from driving (and a good glass of wine with my steak).
I chose to tough it out after the first 7 days or so at home, switched to Tylenol (only thing permitted bc. of aspirin regimen, and totally useless), then went to Aleve. Initially 2/day, then 1, by week 4 pretty much ice, for the most part. However, that seems to be on the very low side as far what most people use.

Jump to this post

This is a new OS, and am going to call office tomorrow and make sure they will make sure I have enough pain meds on board. I have never been one to take much medication, have had opiates for a few days several times after outpatient surgery and dental surgery, but don't like the feeling other than pain relief. He did mention CBD oil but I don't consider that mainstream enough for me. Yes, the opioid panic is certainly overhyped….it has become political…thus some people are not getting appropriate pain relief when needed. Thanks for your input.

@johnbishop

Hi @lblazina, welcome to Connect. I am 9 days post op for total knee replacement for my right knee. I also was a little worried about the spinal tap and the nerve block since I have idiopathic small fiber peripheral neuropathy in both legs but I only have numbness and no pain. My doctor prescribed oxycodone 5 mg immediate release tablets (qty 15) for every 4 hours as needed for pain when the Tylenol 625 mg doesn't help enough. I've been taking Tylenol every 6 hours and it seems to be doing the job for me. I haven't had to take any of the oxycodone tablets. I would have a discussion with your doctor or surgeon about your concerns. My care team did a great job explaining all of the details and possible side effects with me to help alleviate some of the fears I had. I know there is always some risk in surgery but hopefully it's minimal.

I can tell you the second day was the hardest for me which I think is when the nerve block wears off. I still didn't have the piercing pain I was expecting but it was more an ache and soreness. Also the leg still looks like a watermelon so I'm hoping the swelling goes down this next week. I had surgery on the same knee back in the 70s to remove some torn cartilage and they gave me a spinal tap then too. The anesthesiologist really scared me when he came in and made me sign a release in case something went wrong with the spinal tap. I had second thoughts about the surgery but it was quite a treat for me to watch the surgery in the glass cabinets at the side of the room even though they had a sheet blocking my view of the surgeon and his team.

What is your biggest fear?

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John, thanks for the welcome. Hope all goes well going forward for you. I'm glad to hear you haven't needed the oxycodone.

I think my fears are 1-the spinal will cause some awful damage…2-my pain will be dreadful….3-i may have complications such as nerve damage.
Full disclosure however, I am a professional worrier and have never had any serious illnesses or surgeries and I guess that makes me a novice. I am told my pain tolerance is high however, I hope that is true.
Also, I joined a closed Facebook knee replacement group several months ago and keep reading these horror stories about people being in unbearable pain, etc……which didn't help.
I'm confident however that I have found an excellent OS who is very well trained and only does replacement surgery. And I liked him when we did the initial consultation.

@johnbishop

Hi @lblazina, welcome to Connect. I am 9 days post op for total knee replacement for my right knee. I also was a little worried about the spinal tap and the nerve block since I have idiopathic small fiber peripheral neuropathy in both legs but I only have numbness and no pain. My doctor prescribed oxycodone 5 mg immediate release tablets (qty 15) for every 4 hours as needed for pain when the Tylenol 625 mg doesn't help enough. I've been taking Tylenol every 6 hours and it seems to be doing the job for me. I haven't had to take any of the oxycodone tablets. I would have a discussion with your doctor or surgeon about your concerns. My care team did a great job explaining all of the details and possible side effects with me to help alleviate some of the fears I had. I know there is always some risk in surgery but hopefully it's minimal.

I can tell you the second day was the hardest for me which I think is when the nerve block wears off. I still didn't have the piercing pain I was expecting but it was more an ache and soreness. Also the leg still looks like a watermelon so I'm hoping the swelling goes down this next week. I had surgery on the same knee back in the 70s to remove some torn cartilage and they gave me a spinal tap then too. The anesthesiologist really scared me when he came in and made me sign a release in case something went wrong with the spinal tap. I had second thoughts about the surgery but it was quite a treat for me to watch the surgery in the glass cabinets at the side of the room even though they had a sheet blocking my view of the surgeon and his team.

What is your biggest fear?

Jump to this post

Johm – if I read you correctly, you had only the spinal block, and were awake/aware and viewing the surgery?

@lblazina

John, thanks for the welcome. Hope all goes well going forward for you. I'm glad to hear you haven't needed the oxycodone.

I think my fears are 1-the spinal will cause some awful damage…2-my pain will be dreadful….3-i may have complications such as nerve damage.
Full disclosure however, I am a professional worrier and have never had any serious illnesses or surgeries and I guess that makes me a novice. I am told my pain tolerance is high however, I hope that is true.
Also, I joined a closed Facebook knee replacement group several months ago and keep reading these horror stories about people being in unbearable pain, etc……which didn't help.
I'm confident however that I have found an excellent OS who is very well trained and only does replacement surgery. And I liked him when we did the initial consultation.

Jump to this post

lblazina: become a part-time worrier. Ease up. It’s great that you found this forum, and people are super helpful to address whatever concerns you have. I found out about this website after the fact – after TKR, so I might have considered other options if I had known about them, but once I did have the surgery, any concerns can be found or addressed here.

@ellerbracke

Johm – if I read you correctly, you had only the spinal block, and were awake/aware and viewing the surgery?

Jump to this post

@ellerbracke my first knee surgery to remove torn cartilage in the 70s was when I had a spinal tap and no other anesthesia. I was wide awake for that surgery. This last one when I had the knee replacement I had a spinal tap and a nerve block plus anesthesia so I was under until it was all over.

@johnbishop

Hi @lblazina, welcome to Connect. I am 9 days post op for total knee replacement for my right knee. I also was a little worried about the spinal tap and the nerve block since I have idiopathic small fiber peripheral neuropathy in both legs but I only have numbness and no pain. My doctor prescribed oxycodone 5 mg immediate release tablets (qty 15) for every 4 hours as needed for pain when the Tylenol 625 mg doesn't help enough. I've been taking Tylenol every 6 hours and it seems to be doing the job for me. I haven't had to take any of the oxycodone tablets. I would have a discussion with your doctor or surgeon about your concerns. My care team did a great job explaining all of the details and possible side effects with me to help alleviate some of the fears I had. I know there is always some risk in surgery but hopefully it's minimal.

I can tell you the second day was the hardest for me which I think is when the nerve block wears off. I still didn't have the piercing pain I was expecting but it was more an ache and soreness. Also the leg still looks like a watermelon so I'm hoping the swelling goes down this next week. I had surgery on the same knee back in the 70s to remove some torn cartilage and they gave me a spinal tap then too. The anesthesiologist really scared me when he came in and made me sign a release in case something went wrong with the spinal tap. I had second thoughts about the surgery but it was quite a treat for me to watch the surgery in the glass cabinets at the side of the room even though they had a sheet blocking my view of the surgeon and his team.

What is your biggest fear?

Jump to this post

It’s my impression that I am having a spinal tap but will be under light anesthesia so I will not be aware during the surgery. I do NOT want to be awake.

@gobigorgohome

It’s my impression that I am having a spinal tap but will be under light anesthesia so I will not be aware during the surgery. I do NOT want to be awake.

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Guarantee that you won’t be awake.

@gobigorgohome

It’s my impression that I am having a spinal tap but will be under light anesthesia so I will not be aware during the surgery. I do NOT want to be awake.

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Me also….I do not want to be awake and aware, I will not be having general however, spinal anesthesia and propofol maybe?

@lblazina Hi, and welcome to Connect from me also.
I have had two TKRs. I had general anesthesia for the first and for the second I had something that put me to sleep but it was not as heavy as general. I think they call it something like twilight sleep. If you are concerned about the spinal block you should speak to your doctor about it. I had different surgeons for my two TKRs. Prior to my second one, I told the doctor that I did not want a general again. He was fine with that.

I think they will give you some strong pain medications initially but want you to start cutting back on them rather quickly. That's what my surgeon did. I found after a week or so that I only needed the hydrocodone when I went to bed at night. I managed on Tylenol during the day. I cannot take aspirin or any NSAIDs.
JK

@ellerbracke

lblazina: become a part-time worrier. Ease up. It’s great that you found this forum, and people are super helpful to address whatever concerns you have. I found out about this website after the fact – after TKR, so I might have considered other options if I had known about them, but once I did have the surgery, any concerns can be found or addressed here.

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Love it….part time worrier. Yes I will try lol. I'm so glad I found this forum!!

@contentandwell

@lblazina Hi, and welcome to Connect from me also.
I have had two TKRs. I had general anesthesia for the first and for the second I had something that put me to sleep but it was not as heavy as general. I think they call it something like twilight sleep. If you are concerned about the spinal block you should speak to your doctor about it. I had different surgeons for my two TKRs. Prior to my second one, I told the doctor that I did not want a general again. He was fine with that.

I think they will give you some strong pain medications initially but want you to start cutting back on them rather quickly. That's what my surgeon did. I found after a week or so that I only needed the hydrocodone when I went to bed at night. I managed on Tylenol during the day. I cannot take aspirin or any NSAIDs.
JK

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JK, Thanks for the info. Yes, I think it will be what they call twilight sleep and a spinal of some sort. Am speaking with the nurse navigator today and will clarify. Be well!

Hi @lblazina – Glad you found this forum. Welcome! I've had two TKRs – the last one 11 weeks ago. I had full anesthesia both times and I was happy for it. Also, both times the doctor kept me in the hospital two nights, kept a drainage tube in my knee, and prescribed oxycodone for post-op pain when I went home. On the first TKR, I used the oxycodone for more than 8 weeks. On the second, I just used it for about 5 weeks. By the end, in both cases, I was just taking one before PT and one before bed. Are you doing any "pre-hab" physical therapy? I'm a big believer in that making things easier. And, I'm agreeing with the others that this is an important conversation to have with your surgeon. Wishing you the very best. Will you keep us posted?

@ellerbracke

lblazina: become a part-time worrier. Ease up. It’s great that you found this forum, and people are super helpful to address whatever concerns you have. I found out about this website after the fact – after TKR, so I might have considered other options if I had known about them, but once I did have the surgery, any concerns can be found or addressed here.

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@ellerbracke – LOL. I thought you said "become a part-time warrior." (OK. Maybe I need new glasses) But I was inspired! I thought. OK. I could do that too. When I re-read it, I liked "part-time worrier" even better. That will be my goal too! You have provided double inspiration for me today!

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