having spinal & nerve block for TKR

[elcammeno]

When given a spinal block & nerve block for my TKR, will I realize what is going on in the operating room? I really am afraid of that. I have heard that you won't remember the next day what has happened but I want to be assured that at the time of the operation that I am not aware of what is happening.

Elcammeno

 

[kath]

Well elcammeno, can I ask why you want to have the spinal block? Do you have problems with anethesia? You are brave in my book. I was under entirely and I am really happy I went that way. Many years ago (36 to be exact) I did have a completely different surgery done with that method and I could hear what was going on. The procedure they were doing was nothing as invasive as TKR though so it was okay. And that was 36 years ago, so I am sure things have changed drastically.
Perhaps some others on this sight will reply to you that have had that done. Josephine will probably be able to help you.

 

[Josephine]

Yep - Josephine sure can and will!

elcammeno, it is pretty much standard practice to use a spinal with additonal nerve blocks for TKRs these days. There are significant advantages.

1. you don't need to be so deeply anaesthetised, this always hinders recovery
2. pain control during the op is total - yes, even though one is unconscious during surgery, pain killers are given within the anaesthetic cocktail in order to keep the anaesthetic light which is why you wake up feeling zonked (so to speak!) after a general anaesthetic
3. the stress on heart, lungs, liver and body generally is greatly reduced
4. and finally - the BIG plus for you - when you wake you will be totally pain free and remain so for at least a couple of hours probably more.

Now some patients are okay with being awake during the surgery - they like to be aware and be able to ask questions and know (up to a point) what is going on. That's fine. But the vast majority (and I am one!!) want to know nothing!! This is okay too and as a general rule, the anaesthetist will almost always give a dose of hypnoval or something similar to render the patient asleep but not unconscious, meaning they still have control of their airways and breathing, can still cough and swallow, just as you do when you are asleep at home.

And hypnotics like Hypnoval also have the added advantage of creating a short term memory loss so if you should come out of the sedation a bit, then you won't really be aware of it or remember it afterwards. But be assured, when patient is getting lighter, there are plenty of signs to tell the anaesthetist long before the patient gets anywhere near being aware - things like a little rise in blood pressure, pulse and respiration rate. These will be minimal rises but the anaesthetist is trained to be on the alert for them. He will also know when he gave the drug, how long it lasts for and therefore when it is likely to start wearing off. And he will be in there straight away with more.

If all this doesn't reassure you, and it's quite okay is it doesn't, just make sure you tell the anaesthetist when you see him - or even while he is doing the spinal - that you do want to be knocked out for the duration of the surgery. It's quite simple for him and will not be an inconvenience to add in to his routine.

Hope this helps and if there is anything else I can help with, please feel free to come back and ask.

 

[kath]

elcammeno,
I just read an old posting on here and someone had your procedure. She said she listened to music of her choice and actually dozed off a few times. She didn't feel a thing.

 

[beachcomber]

I had a spinal/epidural for my surgery and was soooo glad! I was a bit apprehensive in the prep area so they gave me something to "relax me" a little and the next thing I knew I was waking up in my room and in absolutely no pain (for the first time in longer than I care to think about....). The anesthetist offered to leave the epidural in for either a few more hours or until the next afternoon-- my choice. I was so grateful to be pain free that I chose the next afternoon and remained mostly comfortable as long as the epidural was in place. If the pain breaks through, the dosage via the epidural can be increased (I had a range of med prescribed)--- just ask....

I know the med to "relax" me was Versed and has an amnesia effect which is a little bit weird to think about--- but was well worth the amazing pain control offered by the continued epidural.

I had back surgery only 3 weeks later--- and requested the same spinal/epidural combo-- but was required to have general anesthetic for that one. It was ok...woke up in recovery in some pain, but received pain meds immediately via IV and excellent care..... but my recovery and energy return has been slower and I really believe the general anesthetic was harder on my system...

I have more surgeries in my future--- the other knee and probable revisions someday and will surely ask for the spinal/epidural combination again. You don't have to be awake/aware if you don't want to.

Josephine's reply was terrific--- just wanted to throw in my recent experience as a patient with both types of anesthetic to compare.
I hope it is helpful to you. Good luck.

Carolyn

 

[elcammeno]

Josephine,
Thank you so much for your caring reply. It was very reassuring to me.

Elcammeno

 

[elcammeno]

Carolyn,
I feel sooooo much better after reading your reply about your experience with the spinal/epedural. So glad things went well for your surgeries. Thank you!
Elcammeno

 

[Joanie]

I got a spinal and nerve block with a mild sedative intravenously for my left TKR on January 23rd 2008. Also had this for a bilateral arthroscope last year. Would opt for this every time. I took my ipod down with me and fell asleep listening to music.

It's like anything unknown-the fear can be overwhelming but honestly it's actually a very calming experience-very surreal-you don't think it's happening to you.

The best bit is definetely the recovery-you have no groggy aftermath or pain for hours.

Hope this helps and don't be scared as it's nothing really. As I said previously it's the fear of the unknown, the anticipation that makes it worse. When I eventually get my right knee done, I'll be requesting this too.

 

[elcammeno]

Thank you Joanie for your reassuring reply. I agree it is the unknown-fear that can be overwhelming. I will be glad when I can put this behind me. I need both knees done. I have the choice of doing them four days apart or doing the later one six wks or months apart. I'm having a hard time making up my mind on that.
Again, thank you.

 

[Joanie]

I too need both knees done but on hind sight I'm so glad I wasn't given the opportunity to have both done at the same time. I live in Scotland and have seen 3 surgeons-all 3 don't entertain the idea of doing both at the sme time, all making the same statement-"You literally won't have a good leg to stand on" and I now realise 100% what they meant by that statement. I was 46 in January when I got my left TKR, am now 47 and like yourself am needing the right one done too at some point soon.

I had an idea that the fact that I'm younger and stronger would perhaps be a help in the post surgery phase and I think it has to some extent because I have good upper body strength. Also though, after a nerve block in your leg, you can't independently move it for about one to two weeks so imagine if both legs were like that. As someone else said, the medication does have an amnesic effect-I was in surgery for 3 hours but I'm lucky if I can remember a 1/2 hour. When you wake up, you do hear some stuff but as I said before, you are so relaxed you don't think anything is happening to you. I phoned my husband and mum and dad within 10 minutes of being back in my room to tel them I was okay and how everything went.

Post surgery, I couldn't have done without my athritic right leg which helped me maintain some dignity and independence in the very early stages when being cared for and supported by others.

I am now 4 weeks post op and still not ready to have my right leg done as I know from experience I want my left leg to be a strong as possible as I know what to expect now.

This is only my opinion I am giving to you and ultimately it will be your decision but I always think it's good to get experiences from others who have been through the same. I am such an independent, private person and I would have been mortified if I couldn't have moved both legs on my own-I felt a big enough 'pest' to others but as I say that's just me-you're you.

ultimately, I would say none of it was as bad as what I expected although I'm not saying it's easy either. A strong mind is as necessary as a strong body!!!

Hope this helps and if you have any further questions, don't hesitate to ask.

 

[NuNeez519]

I too am going to have my NuNeez done at different times. The OS I chose (out of a total of 5) will NOT do BTKR. As much as I want to get them both over with I have to say what he told me made me feel more comfortable and that was, "twice the pain in half the time or half the pain in twice the time" with the comfort of knowing I had a "stronger" leg to help post op. I know that not everyone has an unlimited amount of time but in my situation my job gave me the go ahead. The one thing I am SURE of is that I want the epidural! Went for my Pre-Admit testing yesterday and was assured by the Anasthesiologist that the wake up is ALOT more comfortable than general Anas. And I am definately going to ask her to keep it in aslong as posible

NuNeez

 

[Joanie]

I didn't have an epidural Nuneez. I was given oral morphine-as required and slow release with great effect. It was a spinal block and sedative IV I was given for the actual surgery and a peripheral nerve block after the operation into my leg. The spinal and sedative was an alternative to a general anaestetic and the nerve block was to keep my leg more comfortable for a couple of weeks (which it definetely did). A spinal is an injection between the vertebrae of your spine but nothing is left in your back whereas the epidural is left in situ for medication top up post surgerywhich can be a bit uncomfortable if you are trying to lie on your back post op which I had to do as I had had a good deal of ligament reconstruction to straighten my leg.

The pain was kept very well under control with the afore mentioned drugs, paracetamol and anti-inflammatory. This allowed me to do my necessry physio. For me, it was my dignity that was affected most as I've never needed so much help with personal care for any length of time and I just think: How on earth would I have managed with my two legs being affected? That would have affected me so much mentally, if you know what I mean!!! But as I said before, I am such a stubborn, independent person, perhaps that went against me!!! The nurses, physios and my family kept telling me to slow down and I've even been told this by others on this site which I'm now trying to do even though I find it difficult at times!!!

 

[jannd1053]

I had both knees done at the same time. My OS also was not thrilled to do both at the same time, but theywere both so bad I don't think that doing one at a time would have been beneficial for me. I had an epidural-THE GREATEST! No pain for at least 24hours and no lingering effects for days. I'm 11 weeks post surgery and I'm really happy that I don't have to go through it again. Due to the nature of my job, OS suggested another 4 weeks until I go back to work but as the songgoes I feel good the way that I should now! Good luck!

 

[Josephine]

A spinal is an injection between the vertebrae of your spine but nothing is left in your back whereas the epidural is left in situ for medication top up post surgerywhich can be a bit uncomfortable if you are trying to lie on your back post op which I had to do as I had had a good deal of ligament reconstruction to straighten my leg.

Not strictly accurate, Joanie, though near enough and I can see how you made your comparisons. The technical differences actually are:-

- Spinal anaesthesia - local anaesthetic is placed directly into Spinal Fluid below termination of cord at L1 which is right in the middle of the small of your back and about 2-3" above the crease of your buttocks.

- Epidural anaesthesia - local anaesthetic or opiate into fatty epidural space and is more commonly applied at a higher level than the spinal. It is true that a catheter can be left in place although this is not always the case. The catheter used is extremely soft and thin and is taped to the back all the way from the insertion site to the shoulder so the anaesthetist can easily access it during surgery.

- triple nerve blocks involves three crucial nerves (the femoral nerve, the lateral cutaneous nerve of the thigh and the obturator nerve for those anatomists amongst us!!) which can be hit with one injection in the groin and gives excellent additional cover.

 

[elcammeno]

Thank you so much for your reply. My doctor has told me that it is up to me whether I want to do one knee March 5th, then do the other knee either 4 0r 5 days later, or do the 2nd knee whenever I choose to. It has been an agonizing decisions, but the more I think about it, I think like you in that it would be good to have one knee that I can rely one for balance,ect. I am sure that the first knee would not be strong enough by the time the 2nd knee is done. It would be nice to have only one hospital stay & not have to do two sessions of therpy. But I really don't think that is the way to go.
Again thank you for your reply.

 

[beachcomber]

I had the spinal/epidural combination and found it to be excellent.

We left the epidural in until the next afternoon at my request. It was absolutely not uncomfortable at all. I actually reached back to see if it was really there!

I also had to peek under the blankets to see if they really *did* anything to my knee because other than having muscle spasms brought on by the little "foot squeezers" I remained very comfortable.

this was an excellent choice for me and I will use this method again-- unless something recommends something better for my other knee. But I hope that is not anytime soon! I still have some cartilage left in that one.

 

[beachcomber]

Re: having spinal & nerve block for TKR/BTKRs

When you all mention the Bilateral TKRs.... I just can't imagine having them done at the same time or so close together....

I can't even figure out how I would have managed in the bathroom-- let alone in the rest of my life. I bought a toilet extender and still had a hard time balancing my op knee on a stool and getting comfortable to actually *do* something......and we're not even talking about the amount of time balanced there and the infamous 'roids previously discussed by this group...

I ended up in a "regular" non-handicapped bathroom recently and had a heck of a time managing getting down and then back up without an extender and hand-rails. I can blame my 1 month ago back surgery as well as my PKR--- but still..... it was a struggle and I have one "sort-of good" knee.

And the shower.... I "practiced" getting in and out before my surgery... but it was still hard to swing my op leg over the bathtub when it wasn't bending very far. I am long-legged enough I was wishing for an extra long bathtub! Balancing on the other leg and trying to shower fast without slipping..... I was so glad I had "the other leg" to use!

And trying to do PT on both knees...I can't even imagine....

I am in awe of your courage and determination. Truly.

All the best to you!

 

[jannd1053]

Hi beachcomer' I had a tub/shower chair so I was able to sit and not have to worry about my balance. Couldn't have managed without it.

 

[NuNeez519]

I now have 5 days until my first TKR and am alway preparing. I removed area rugs (good time for a dry cleaning anyway), placed a rail 36"s onto the side of my shower (non permanent), have a shower seat (that folds), toilet raiser that locks on, a reacher and something for my own comfort a lifting reclining chair which I will give to my Pops after I am all better! The only thing left for me is this "Bring On The Pain" cause I can not wait to get into that hospital knowing that a few months or years after I will be able to ride a bike with my children or walk thru Central Park or the zoo knowing dad can do it! Cause right now I can't and I am lucky my only child is 9 and understands. One of the last things that also helped me make up my mind is when my daughter did ask me, why I could not walk and if I was born hadicapped (not that thre is anything wrong with being handicapped, my Pops is blind and my sis has no use of her left hand due to a tumor at birth) Soif there is something WE can do to help our quality of life, lets take advantage of it, cause my Pops said if he was able to get new eyes he would and sis says if she could get a new left arm she would also.

Hope this helps,
NuNeez

 

[Josephine]

Honey, I shall be walking every step of the next 5 days with you. (Can't help it - I'm a nurse!)

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