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.

@debbraw

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?

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Yes, Debbra, will try to keep posting. I have surgery date now…June 4. Will attend a pre op day two weeks before to have labs done, CT scan, EKG, and speak with hospitalist. Am having surgery at a dedicated ortho surgical center…they have their own surgical suites, etc., plus their own post op floor only for their patients so don't have to be in general med surg part of hospital with sick patients..a big plus. Nurse assured me today they will prescribe opiates for post op pain. I am not having pre hab. When I saw OS, he says I don't need it….I am a swimmer and have always been physically active so leg muscles are in adequate shape I guess…at least he thought so. Also, I have good range of motion in that knee……although it is bone on bone…..not sure I understand that but it is what it is…..I limp around and hurt, but if I am in water, I can swim laps including kicking for an hour….lol sounds strange. Anyway, I appreciate the support on this forum and so glad I found it. I hope your recovery continues easily!!!! Thanks.

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@debbraw

@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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I know for certainty I am a worrier….it is one of my special gifts LOL……but hey, part time warrior sounds good….I am going to work on that one!! New goal for me!!

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@debbraw

@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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@debbraw I totally agree. Preparing for a TKR is extremely helpful. I am sure I have mentioned that my original TKR was scheduled for February, 2014 but my platelet count was too low to have it done. That was prior to my cirrhosis diagnosis. I was finally able to get the knee done in October 2017, a year after my liver transplant. That gave me plenty of time to prepare by exercising, primarily my recumbent bike and water jogging, both of which were highly recommended by my orthopedic surgeon,
JK

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@lblazina

Yes, Debbra, will try to keep posting. I have surgery date now…June 4. Will attend a pre op day two weeks before to have labs done, CT scan, EKG, and speak with hospitalist. Am having surgery at a dedicated ortho surgical center…they have their own surgical suites, etc., plus their own post op floor only for their patients so don't have to be in general med surg part of hospital with sick patients..a big plus. Nurse assured me today they will prescribe opiates for post op pain. I am not having pre hab. When I saw OS, he says I don't need it….I am a swimmer and have always been physically active so leg muscles are in adequate shape I guess…at least he thought so. Also, I have good range of motion in that knee……although it is bone on bone…..not sure I understand that but it is what it is…..I limp around and hurt, but if I am in water, I can swim laps including kicking for an hour….lol sounds strange. Anyway, I appreciate the support on this forum and so glad I found it. I hope your recovery continues easily!!!! Thanks.

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@lblazina – I think you are going to do great. I gotta tell you that I knew when I needed my first TKR when just doing laps with a kick board caused pain. Sounds like you are strong and ready! You go girl.

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@ulbazina – I had my left knee TKR on Mar 8 at the Mayo in Rochester. I was a nervous wreck about anesthesia. A week prior to my surgery I was able to meet with one of the anesthesiologists from my surgeon's team. It was so great that she took the time to explain my options and listen to my concerns. I ended up having midazolam and then a small dose of fentanyl to prepare me for the nerve block bupivacaine just above my knee area Once I got in to the OR I had an epidural (I think it was Ropicacaine). I was told that the epidural is injected below the spinal column (nerves area). While they were doing that I was given a dose of propofol and I was out. So I had no heavy anesthesia and I woke up in recovery bright and alert. The knee block wore off over the next 24 to 36 hours with no side effects.

I hope that you can meet with an anesthesiologist to put your mind at ease.

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Hi @lblazina, I had my right knee done at Mayo Rochester on April 5th and had a similar experience as @kajon. I wasn't quite as worried about the options but the anesthesiologist did a great job of talking me through them and about all I remember is being rolled into the operating room with all those bright LED lights overhead. Woke up feeling pretty good in the recovery room and like @kajon the nerve block on the knee wore off by the next morning and I was release around noon. Mayo does a great job addressing any concerns or fears you have.

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@kajon

@ulbazina – I had my left knee TKR on Mar 8 at the Mayo in Rochester. I was a nervous wreck about anesthesia. A week prior to my surgery I was able to meet with one of the anesthesiologists from my surgeon's team. It was so great that she took the time to explain my options and listen to my concerns. I ended up having midazolam and then a small dose of fentanyl to prepare me for the nerve block bupivacaine just above my knee area Once I got in to the OR I had an epidural (I think it was Ropicacaine). I was told that the epidural is injected below the spinal column (nerves area). While they were doing that I was given a dose of propofol and I was out. So I had no heavy anesthesia and I woke up in recovery bright and alert. The knee block wore off over the next 24 to 36 hours with no side effects.

I hope that you can meet with an anesthesiologist to put your mind at ease.

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Thanks, @kajon, for the good information about your experience. Knowledge is power…I think…I go for a full day of "classes" a week before surgery for ekg, blood work, meet with PT, hospitalist, and other health professionals so should get all questions answered. Glad you had a good experience. Hope I do as well!!

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@johnbishop

Hi @lblazina, I had my right knee done at Mayo Rochester on April 5th and had a similar experience as @kajon. I wasn't quite as worried about the options but the anesthesiologist did a great job of talking me through them and about all I remember is being rolled into the operating room with all those bright LED lights overhead. Woke up feeling pretty good in the recovery room and like @kajon the nerve block on the knee wore off by the next morning and I was release around noon. Mayo does a great job addressing any concerns or fears you have.

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@johnbishop , thanks for the encouragement. I hope I get to an altered state of consciousness before the spinal!! I think I am having a nerve block on leg also. I'm thinking positive. Thanks!

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@debbraw

@lblazina – I think you are going to do great. I gotta tell you that I knew when I needed my first TKR when just doing laps with a kick board caused pain. Sounds like you are strong and ready! You go girl.

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Thanks for the support @debbraw. Good to know this group is here!!

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