TKR Conscious sedation memories?<

MeganAC

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Hi all.
I had RTKR on June 27. I found this site about a week ago after searching to find whether my pain and nerve issues were normal. I have to admit I have been lurking the threads since then.

When I went in to the hospital and was in the pre-surgery area the anesthesiologist came in to discuss whether the surgery would be done under "conscious sedation" with a spinal block and sedatives. I asked the pros and cons of each and after listening to the explanations of each, I chose conscious sedation as I was told there were fewer complications, a better overall post-surgical recovery time, etc. I told him I would be willing to do it, but I was concerned about the "conscious" part of the equation. He assured me that it would not be a problem.

I have some very specific memories from the surgery. I went to PT for the first time this morning and I am not sure why, but asked him if he had any patients who had any memory of their surgery. He said no. I shared my experience and he was horrified and verified that what I said would have happened during the surgery. I am wondering if any others have any memory of their surgery if they underwent conscious sedation?
 
Hello @MeganAC - and :welome: to recovery.
It sounds as if you're doing well.

A few people remain conscious by choice during their surgery, but most people choose to sleep through it.

Here is the recovery reading we give to everyone with a new nee:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Thank you, @Celle.

I suppose if I had understood the possibility that I would actually have a recollection of what happened, I probably would not have chosen "conscious sedation". In fact, I told the guy that I did not want that to happen. I was given the impression that the "conscious" part was a remote possibility, and even if I "woke up", I wouldn't have any recollection. I have very specific sensory memories (e.g. metal on metal hammering on my leg), as well as recall of conversations I had with the anesthesiologist (e.g. staples v. stitches). I am curious if others have any unexpected memories of their surgery.
 
Hi and Welcome!

How are you doing emotionally with these memories?
 
@MeganAC so sorry you have these memories hanging over you. Perhaps talking about them with others here will help.

I woke up during my LTHR and was told I could not have any more sedation. I remember lots of "carpentry" and the selection of the actual implant size. I finally willed myself back to sleep but the first few days post op were a bit rough. Almost like having a bad nightmare and not being able to shake it off.

Just before going in for my second THR I had a discussion with the anaesthetist. I told him about my experience and said I did not want to see or hear anything throughout the procedure. He did say waking up does happen sometimes but it is very rare. And he promised to watch me throughout the procedure to insure I was "under". I am happy to say I do not remember a thing about my RTHR surgery except waking up in the recovery area.
 
I don't know how long it was into the surgery, I remember the anesthesiologist asking me to move my arm. I woke up to the sound of metal clanging and feeling the jolts in my right leg and hip moving in time with the clangs. I asked what they were doing and the anesthesiologist told me that they were "Just putting the prosthetic in." I reached for the surgical curtain that was separating my view from the action on the floor and he grabbed my hands and told me not to do that. One of the surgeons said something to the anesthesiologist and I was out again. Then I came back up and asked what was happening and was told they were closing up, I asked whether they were putting staples or sutures and he replied sutures. I remember some conversation about that as I felt the tug of the "sewing". Nothing was painful, and at the time I felt mild curiosity about what was going on. Now, I am not so happy about it.

During the pre-op consultation, the anesthesiologist said something about some people just talking all the way through the surgery about what was going on. I specifically told the anesthesiologist that I did not want to be that conscious of what was happening, I thought it would be scary. My husband even reiterated that being awake would not be a good thing. He replied, he would keep me under but he just wanted me to know it was a possibility.

When I talked to my PT about it, he was horrified. He said that he has been in the OR when people become aware and most surgeons are NOT happy about it. To be honest, I am a little angry about it myself. You're right, @Jaycey, it is sort of like having a nightmare that won't go away. I will definitely be discussing it with the OS when I have a 6 week follow-up appointment.
 
I had recently another operation shortly after my tkr where they gave me a spinal and it did not work but they insisted I be ok and during operation I could feel every thing - I told surgeon and they panicked and quickly gave me a GA- Surgeon was surprised I was so calm and ok about it . though suffered a nightmare or two a couple of days later. do not want to give to much of detail has it does frighten people from having OP done
 
I could feel every thing

Oh my! That sounds horrific, @bland9! I am glad they were able to put you under GA after the procedure had already started.

As I mentioned, I didn't feel any pain. It was more like an out of body experience. I could hear the doctors and nurses talking and feel the pressure and movements and I was interested in what was going on in a matter-of-fact sort of way. But thinking back on it, I feel disturbed.
 
I recall drifting into wakefulness at least twice during my procedure, once when there was a lot of heavy hammering happening... I assume when the implant was being seated. I wasn’t overly concerned and treat it as a curiosity. I pan on asking the surgeon about it at my 8 week follow up.
 
As it is, I am nearing 4 weeks. My recovery has been bumpy, as is the case for everyone, it seems. I really did not fully understand how difficult this surgery would be. I think they downplay everything on the front end, otherwise a lot of people wouldn't dare do it.

Reading other people's posts, I realize I actually elected to do the surgery pretty early in the progression. I wasn't taking any medication other than the occasional naproxen to control the pain which was mostly limited walking over any distance and going up and down stairs. In some ways, it feels like having a "healthier" knee on the front end of surgery makes for a more difficult recovery on the back end. In fact, up until May, I thought it would be my left knee that would be replaced as that was the knee I was visiting the orthopedist about.

My biggest concern right now is pain management, as my OS will not prescribe any more oxycodone 5 and my insurance company won't cover any more without jumping through hoops. Even with 2 refills I only had just over 2 weeks worth using it as recommended. I was able to stretch it to over 3 weeks mixing with the other prescribed meds- Tramadol 50, acetaminophen 1000 and naproxen 500, but with some pretty severe breakthrough pain episodes in the last week (8 or 9 on the pain scale). I called on Monday for a refill and was told they would not prescribe any more oxy. They replaced it with hydrocodone 5/325 yesterday. I was up half the night as the new bedtime prescription cocktail did nothing to cut the pain.
 
I'm sorry your pain isn't being controlled better. I'm going to ask @Josephine to advise you abut that.

How active are you being? Sometimes, doing too much at this early stage of recovery can contribute to your pain. Did you check your activity against this article that I left you? Activity progression for TKRs
 
Sorry your pain is not well controlled. Have you been icing and elevating a lot? Four weeks is still early in your recovery--do check out the activity progression link Celle left for you in the previous post.
 
I acknowledge that I am probably overdoing it on the activity side, especially on the weekends when my husband and kids are around. During the week it is easier to avoid overdoing it because everyone is at work and I am able to just relax, ice, and elevate.
Today was actually pretty good, pain wise. I spent most of the day doing homework, resting, icing and elevating. Then, feeling pretty strong and confident, I agreed to go out to a local pub for a bit with my husband as he has the day off for a local holiday. About 20 minutes in I knew I had made an error. Hubby was kind and we left after I explained that I will probably be paying for our little excursion tonight and well into tomorrow. I am back on the couch, feet up and knee attached to my little polar care unit.
 
I had a spinal for my left knee three years ago and no problem, said I didn't want to be awake at all and didn't wake until recovery.
For my right knee 7 weeks ago again had a spinal with a very young anesthesist. Again reiterated that I didn't want to be awake and she sluffed it off saying I wouldn't remember it or whatever. I had little confidence in her as she had difficulty inserting the IV.
Needless to say at the sawing stage I woke up, could hear everything saw the monitors etc. Was awake for a while and commented on it. I did go back but then came to just as it was finishing up.
I did mention it to my OS and asked if he had worked with this dr before but he hadn't, it's not his regular hospital, only is there a few times a month.
I haven't really had nightmares about it but for sure wasn't happy about it.
The other part was it took 24 hrs for them to get pain meds right.
I kind of think of it as "an experience". Hopefully not to be experienced again
Hope all is going better for you now.
My right knee wasn't as bad as my left and i think sometimes recovery is harder as the before pain wasn't as bad.
I'm getting there but it seems slower this time.
Good luck on your recovery
 
I am sorry that happened. @Sunnyo. I agree with your characterizing it as " an experience" that I would not like to have again.
I think there is something to be said about recovery being harder when the before pain isn't as bad. I do feel like I have turned a corner, each day a little better than the last. The swelling has gone down substantially. I am able to control the pain a little better with fewer meds, ROM and endurance are increasing little by little. But everyday is like trial and error, how much activity is too much?
 
my OS will not prescribe any more oxycodone 5 and my insurance company won't cover any more without jumping through hoops.
There may be other ways of managing your pain. I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Jolly good!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 

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