TKR Had my pre op today (a bit of hesitancy before)

[Nyland]

Hello everyone. I had my pre op today which was a big deal because of the hesitancy that I had been feeling. Let me explain. When I had my right knee replaced (10 years ago) I used oxy to mange the pain and it worked perfectly. Since I had my gallbladder out, I am one of the 1% that losing their gall bladder caused opioid induced biliary spasms. So...I reached out to 2 of my anesthesiologist friends to ask them about a pain management plan without oxy. My first friend's plan was iffy and it scared me. My 2nd friend was very real. He told me that he and his peers believe in a multimodal analgesia and for me he suggested tylenol, tramadol (I can tolerate that), gabapentin, & motrin. He told me to keep oxy on the table because I may need it, but could weigh the risks (spasm pain) & benefits (knee pain management). I liked his advice and went to my preop. My friend also said that he could insert a catheter for pain management. When I told him my surgery was set for out patient he said that option would have to be taken off the table.
Anyway, I went and unless I checked out, October 5th is still my date.

 

[Jaycey]

tylenol, tramadol (I can tolerate that), gabapentin, & motrin

This is a very common pain management cocktail. Your job post op will be to work with staff to get your pain managed before leaving the hospital. Don't feel rushed.

All the best on the 5th! We will be with you all the way!

 

[Nyland]

Thanks, Jaycey. My anesthesiologist friend told me that the block would take care of the pain for several hours after surgery. Maybe that's not good thing if I don't know how the cocktail is working before I leave? 10 years ago when I had my right knee replaced, I was in the hospital for 6 days. By the time I got home, I was on the path to recovery. I hadn't had my gallbladder out yet and was able to take oxy when needed.
My poor husband is going to have his hands full. Heaven help me.

 

[JusticeRider]

Hi Nyland, welcome to the forum! It’s a great bunch of people with a lot of knowledge to share. I can’t tolerate narcotics so I was stuck with just Tylenol and a small dose of Celebrex after my surgery. The biggest thing I would encourage you to do is get an ice machine if you don’t already have one and ice, ice, ice. Ice was the only thing that got me through, that first week especially. I have used the Ossur Cold Rush which is on Amazon for something like $199. You put some water in the tank and some frozen water bottles and it pumps ice cold water through a wrap that goes around your knee. If you have 8 small water bottles, you can rotate them in and out of the freezer. I set up my ice machine next to my recliner and used it a LOT, and still do.

 

[Susie-Q]

My friend also said that he could insert a catheter for pain management. When I told him my surgery was set for out patient he said that option would have to be taken off the table.

Did he say why you couldn't have a pain catheter? My second TKR was also out patient and I came home with a nerve catheter in my thigh and a pain med ball that lasted 5+ days. I removed it myself when the ball was empty.

Yes, the ice machine will be your best friend!

 

[kneeper]

Hi Nyland, welcome to the forum! It’s a great bunch of people with a lot of knowledge to share. I can’t tolerate narcotics so I was stuck with just Tylenol and a small dose of Celebrex after my surgery. The biggest thing I would encourage you to do is get an ice machine if you don’t already have one and ice, ice, ice. Ice was the only thing that got me through, that first week especially. I have used the Ossur Cold Rush which is on Amazon for something like $199. You put some water in the tank and some frozen water bottles and it pumps ice cold water through a wrap that goes around your knee. If you have 8 small water bottles, you can rotate them in and out of the freezer. I set up my ice machine next to my recliner and used it a LOT, and still do.

Before you buy anything make sure they don't send one home with you. With my second knee I had an ice machine in the hospital and they sent it home with me.

 

[Nyland]

I'm ready. My surgery is on Wednesday. I have let go of my angst about not knowing if I will go home the same day or will be required to stay. At first I was confused, but .....oh well. I packed my toothbrush, nighty, brush, nighty, underwear and PT clothes. Whatever happens, happens.

My PT will be outpatient. Last time they came to the house and I actually preferred going there. My husband had them come to the house. too. Now we go to the facility. I have my first appointment which is sooner than I was discharged last time. I find that amazing.

I am ready. Soon it will be behind me and I can concentrate on recovering.

Ny


The anesthesiologist was referring to a nerve block catheter. He would not do it for outpatient. He follows clinical guidelines. I am a provider in the same hospital and we take our policies and clinical guidelines very seriously.

My surgeon will not allow a PCA pump. This is an academic medical center and my surgeon designs patient plans by outcomes. He publishes extensively and takes all research outcomes of his peers very seriously. That being said, I spoke to my anesthesiologist friend on 9/19, the day that JAMA published an article about gabapentin's outcomes being so poor that it should not be used peri or post operatively for pain management. I sent it to him, but he hasn't responded. he is either spending time with his family or trying to figure this out. I know that he has been on call in the SICU for the past 2 weeks, so my guess is he is with his family.

I have an ice machine from my (and my husband's 2) total knee replacements. I prefer frozen peas <LOL> to the ice machine. I filled my freezer with 30 bags of frozen peas on Friday.

 

[lovetocookandsew]

I am unable to take any kind of pain meds at all, other than Ibuprofin, so my OS had to work around that. He had an epidural for pain after surgery inserted while I was in the OR, which stays in about 3 days, then I had a pain ball inserted after the 3 days for my revision and the ON-Q brand pain pump after a couple of subsequent surgeries. They can be set to different levels, and will last as long as about a week or 10 days, if I recall correctly. It saved my sanity and a lot of pain, as with it in I was basically pain free.

Because of the pain issues, I always have to stay in the hospital at least until the epidural is finished, and the pain ball is working well. I also use my ice machine around the clock, with a break every hour or so to walk around some, plus I elevated whenever I was using the machine. The ice machine is a great form of pain relief, and also saved me from untold pain. A bag of peas wouldn't have done anything for me as they only stay icy cold for a very short time and changing them every 20 minutes would have been a pain, instead of the ice machine which lasts about 6 hours before needing a quick change of frozen ice bottles. This surgery, as you know, means a lot of pain during at least the first leg of recovery, so I wouldn't go through it if I couldn't have any pain relief.

 

[InkedMarie]

Good luck on Wednesday!

Marie

 

[Susie-Q]

Good luck, @Nyland and keep us posted on your recovery!

 

[benne68]

I filled my freezer with 30 bags of frozen peas on Friday.

Then you are definitely ready! Since this is not your first time, you know what to expect.

Looking forward to hearing from you in the Recovery Forum, once you are feeling up to it, so we can support you on the other side.

 

[JusticeRider]

Nyland, I hope your surgery went well today! Onward and upward…! Let us know how you’re doing when you feel up to it.