TKR Day 8 and having trouble with pain meds...

[Gardeningal2003]

LTKR on Monday 4/16; home for rehab on Friday 4/20. Had an epidural for my surgery, and then for pain management, the PCA with dilaudid, as well as roxycotin. Had very bad pain and did not feel well at all, pretty much my whole hospital stay. Apparently my low BP affects pain management and I couldn't have what I really needed as they felt my BP was going too low.

Was sent home on percocet 5/325 1-2 tablets every four hours if needed maximum daily dosage of 5. 1 does not do the trick, so have been taking two pretty much every 4-4.5 hours, except when I wake in the middle of the night when I take one.

My understanding is that the restriction to 5 p/day is not on the amount of oxycodone in the percocet, but on the aceteminophen, so yesterday called the doctor, who prescribed the oxy without the aceteminophen, which I have not yet picked up from the pharmacy.

However, this morning, out of the blue, I started vomiting shortly after I took the percocet. I have also had a very annoying rash for the past 6 days - all over my back, behind my knees, and now some small bits on my abdomen, which they told me at the hospital could have been an allergic reaction to the sheets.

So, called the doctor, who recommends that I switch to dilaudid. That the perc could cause the rash as well as the vomiting. Does anyone have any experience with any of these reactions, or advice as to the dilaudid use? I hate all this stuff, but am not the most stoic person I have found - I definitely need something, especially before PT!

Thank you!

 

[bottomshollow]

Oh, Gardeningal, I feel your pain :cry4:. So sorry you're having trouble with the pain meds. "Cause you are exactly right, even if you don't like them, you gotta have them.

I have no answer to your questions, so I'll tag Josephine as I'm sure she can give you the info you're looking for. @Josephine:

Keep us posted. We care.:console:

 

[Jamie]

It does sound like your body may not like the percoset. I would switch to what your doctor recommends and, if it doesn't do the trick for you, let him know. Proper pain management is critical for a smooth recovery.

 

[ship4]

However, this morning, out of the blue, I started vomiting shortly after I took the percocet. I have also had a very annoying rash for the past 6 days - all over my back, behind my knees, and now some small bits on my abdomen, which they told me at the hospital could have been an allergic reaction to the sheets.

So, called the doctor, who recommends that I switch to dilaudid. That the perc could cause the rash as well as the vomiting. Does anyone have any experience with any of these reactions, or advice as to the dilaudid use? I hate all this stuff, but am not the most stoic person I have found - I definitely need something, especially before PT!

Thank you!

I am allergic to percocet. Same reactions. I knew before my BTKR and was prescribed Dilaudid 2mg and Visteril (generic) 25 mg along with Celebrex. This worked great for me. Hopefully the Dilaudid does the trick for you.

 

[Gardeningal2003]

Thank you everyone! I think that when the coumadin therapy is over (and I believe that will be on Sunday) I should some more options, too. My sister and right-hand gal (thank goodness for her!) has gone off to pick up the new medicine - let's hope it works!

 

[Jamie]

 

[maryo52]

Getting the pain management figured out is one of the big challenges of this surgery. I've never had dilaudid but I hear it's very effective. Tramadol is another alternative to have in the back of your mind. But hopefully by the end of this day you'll be more comfortable. Best wishes for a smooth recovery!

 

[Gardeningal2003]

Well, I started dilaudid 4 mg every 4 hours yesterday, 4/26, at 4 p.m. Took the 8 p.m. dose and then again at 4 a.m. Am not getting NEARLY the relief with this as I did with the percocet. This was the first night I could not get comfortable in my bed, and I had to sleep downstairs in the recliner.

I had been doing so well - walking well with the cane only, and was able to flex my knee, both in the pm machine and on my own, and had it up to 75 degrees ROM. I was sitting and standing from a sitting position, and able to lift my leg off the bed several inches for a count of 20, and now I can't lift at all - I get terrible pain in my quads. I really feel like I'm going backwards instead of marching forward! I have no clue how I will be able to do PT this afternoon, compared to how I did on Tuesday when I was on the percocet.

Anyone have any suggestions for better pain management for me? I hate being a P-I-T-A, but guess I do need to call the doctor for some other suggestions, right? Or is this "normal" pain, and what everyone has - I have no reference point, I guess. Frustrated! Thank you all - it's so great to just be able to put my thoughts out there...

 

[Nyland]

Hi Gardeninggal,
Skip PT today if you are not up to it. Some other people have posted that rest and ice along with their pain meds help. Definitely call the doc and try resting and icing today. Let us know what works. Best wishes.

 

[Lindawalms]

I would contact your dr - you can up your dilaudid only IF your Dr approves it! I took more than 4 mg at once but then again I am opiod tolerant. Also you could try taking something else in addition like tramadol too...just a suggestion - good luck!!!
xoxo,
Linda.

 

[Jamie]

You need to work with your doctor until you find the right pain medications to work for you. There are LOTS of choices. The pain you're having is not something you should have to endure. It will make recovery much more difficult.

 

[Janet2012]

Perhaps this is an appropriate place to ask this. I've never had major surgery, so these pain med options are largly unknown to me. I asked, and my OS prescribes Percoset. I'm wondering what I should generally expect from this drug. Is it an entry level pain drug that may be enough, or is it a big gun that will do as much as anything would? If I struggle with pain on that, where do I go from there? Are there more or fewer side effects than some of the other options? I looked in the library and didn't find anything that lists a scale of drugs, what kind of drug it is, what it does, what to watch out for, how to take them, what can be taken together, etc. (and what they are called in respective countries). Maybe that's too much info to gather, and in the end, it's up to the doctor, but if we are to take control of our pain management, I would like to know what I was talking about. @Josephine:

 

[bottomshollow]

Janet, you can Google the various names of pain meds you've seen mentioned here. However, what your personal reaction to any one of them will be is something you will only find out once you've taken it.

I took percocet 5/325 (5mg of oxycontin and 325mg Tylenol). In the beginning I took 2 every 4 hours, reduced after 3 weeks to 1 every 4 hours, then by week 5 only took 1 or 2 at night. They did not make me feel loopy or fuzzy. But did help me nap during the day. I did feel vaguely nauseated in the morning but was never sick from them. And they definitely kept my pain at bay. But others have not been able to take this drug.

Hope this is somewhat helpful.

 

[Josephine]

You should look at this article where there is a table that will tell you some of what you want to know The importance of managing pain after a TKR and the pain chart Side effects are better Googled as we cannot contain everything in here.

 

[Gardeningal2003]

Well, from my experience with this surgery, I can say that I think the percocet 5/325 was more effective in managing my pain than the dilaudid 4mg is. However, I had the mysterious rash which the doctor believes came from the perc, and I had the one episode of a really upset stomach on it. Honestly, I think that happened because I dosed too close together - when I took the medicine in the night, I thought it was at 5 a.m., however, my DH says it was def at 6! And then I took the next dose too soon.

So, the OS switched me to dilaudid 4 mg every 4 hrs. The rash is getting better (would it have anyway with time?) thank goodness, but I don't feel the dilaudid is as effective as the perc was in managing my pain. Even with supplementing with Tylenol for Arthritis Extended Pain 650 mg. I have a bit of underlying nausea which I'm hoping will go away with use (I just eat a little bit of something plain on a regular basis - it makes my stomach feel a bit better).

I called today that to see if there was anything I could do to supplement the dilaudid, and the PA agreed that the Tylenol was a good idea, and TO ICE CONSTANTLY. He said ICE - not peas, corn, the cooler - just the equivalent of two trays of ice in a double Ziploc, separated from your skin by a thin towel. And he said I could increase the dilaudid to 6 mg. But since my stomach is a bit upset, I'm using the ice and the 4 mg/tylenol combo and getting through it. PT said I did GREAT today and that he is so proud of me, so am gonna grin and bear it and hopefully it will be better tomorrow.

Guess everyone needs to come up with their own combo that works, and at this point this is mine. Thanks everyone for your support and advice. Hopefully my story will help someone else answer their own questions!

 

[Janet2012]

Thanks all! See, I didn't even know percocet was a combo drug. I tell you, I keep thinking back to a bad experience I had, some 40 years ago. I was given Darvon after slicing my arch open on a garden tool. I took the max, 2 every 4 hours I think it was. I was incapacitated by it. I remember laying on the sofa and being scared to death, but unable to move to call for help. The door was open and I kept hoping someone would come to the door. After four hours, it lifted and I was able to get up and go sleep it off. I'm a little nervous about these drugs!

 

[Josephine]

I had Tramadol and it suited me very well along with the paracetamol (Tylenol).

 

[jancat]

Sue, do you have an ice machine? There are a lot of variants, but basically it is a cooler that you fill with ice and water and it attaches to a cuff that circulates this icy water through the cuff around your knee. A friend lent me one and it works great. I also bought 'frozen peas' which are actually tiny gel-filled balls that you freeze and apply like peas. Less mess than ice. Happy healing!

 

[grabbit97]

I was on NORCO for a month, and it made my system so constipated, I quit, and switched to tramadol and tylenol, eventually switching to tylenol and advil (josephine's COCKTAIL) and that worked very well.. but I was farther along that you are now, the NORCO made me so sick, I started weaning off of it, and was on tramadol for a while...
You need to try different things, until you find one that works for YOU... ask your DOC... he will know best...
Good luck...

 

[beachlily]

I threw up terribly from tramadol- ended up in ER- glad I only need tylenol for LTKR or I don't know how I could handle pain meds