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Discussion in 'Knee Replacement Pre-Op Area' started by Cynof4, Apr 25, 2019.

  1. Cynof4

    Cynof4 junior member
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    Exparel for post op pain management? Game Ready worth the expense?

    Bonesmarties:

    Has anyone had experience with Exparel injected intra-operatively for pain management vs. femoral nerve block? I've read several studies indicating it might be beneficial. Any opinions ?

    Since my insurance will not cover an ice machine I need to find one on my own. I've heard glowing reports about Game Ready. Has anyone rented one? How much is the rental? Or used one? Is it worth the expense or should I stick with something less expensive? Thoughts...???

    Thanks!
    Cynthia
     
  2. ulrich2000

    ulrich2000 junior member

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    Hi Cynthia,

    A little over 3 weeks out from BTKR. I’d vote strongly for the Game Ready. After several days the Cold+ Compression mode is fantastic. Initially you’ll be too sore for compression but the 360 degree cold treatment is very effective by itself. Wrap your leg in a pillow case first- it’s more comfortable. The cost is about $120 per week. I’m extending till I don’t feel any more benefit. I do use regular ice packs in between as well just for convenience or quiet. This unit uses a lot of ice.

    As for the blocks exparel can last longer but each doc / hospital has their own protocol. I’d go with what your surgeon / anesthesiology team has the best experience with.

    Ulrich2000
     

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  3. julieskan

    julieskan junior member

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    Here (CA, USA) Cold Therapy Machine is recommended. I'm taking that one down.
     
  4. rosieNZ

    rosieNZ member

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    Hi. Yes to Game Ready. I can only compare my experience with 2 TKR 2 years apart. No 1 was a challenging experience. No 2 with Game Ready was fab!
    I am in NZ. It was about $200 a week to hire and I hired it for 2 weeks.
    I used it with discomfort from day 3 post op. At first I used minimal compression the turned it to medium level. I was comfortable. I just let it cycle ,5 hour on and ,5 off. Swelling and pain was well controlled.
    I possibly should have hired it another week but used my Aircast instead. For me it was not as good as GR, The 460 ice and compression was impressive. Best wishes
    . Rosie
     
  5. Momma-me

    Momma-me member

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    I bought a used Game Ready on ebay.
    I'll let you know what I think!
     
  6. Cynof4

    Cynof4 junior member
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    @rosieNZ ,

    I contacted the Game Ready folks today. I think I'm going to rent for a month. The quoted rate in USD was $140.00 per week. I'll know more about deposits/s fees after I send them the script from the orthopedist. I'm feeling like I only have the chance to do recovery right one time so I'm going to do everything possible to make the right choices! Thanks for the advice!
     
  7. Cynof4

    Cynof4 junior member
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    @Momma-me,

    I looked on Ebay as well but the ones I found were still in the $1,200- 1,500 range. Was that your experience? I am a little weary of what condition they will be in. Please let me know how yours works out. It may be worth the investment if we use it more than once.
     
  8. Cynof4

    Cynof4 junior member
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    @ulrich2000,

    Thanks for the tip about the pillow case! I definitely don't need frostbite on top of everything else!:loll:
    I'm sold on the Game Ready and following multiple pathways to make sure I get one!

    As for the Exparel, I appreciate the advice to follow the surgeon's and anesthesiologists expertise. Normally, I would agree. However, I have extreme anxiety about post op pain and need to know that I will be listened to as well. I had a very bad childhood post-surgical pain experience. So far the post op pain management plan is Percocet, and I'm not happy with that. I'd rather avoid opiates and the ensuing constipation they cause me. I'm planning to have a conversation about this with my OS at my pre-op appointment. My brother, who is also a surgeon, suggested that Exparel might be the best choice for me. No harm exploring options, right?

    I hope your recovery stays on track! Best wishes,
    Cynthia
     
  9. Celle

    Celle FORUM ADVISOR Forum Advisor

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    It's a very good idea to discuss all this with your surgeon at your pre-op appointment. Be sure to tell him/her about your childhood experience as well.

    I understand your desire to avoid opiates and their side effects. However, most people do need opiate pain relief, at least for the first few weeks. Be prepared for the constipation. Have milk of magnesia or your favourite remedy to hand. If necessary,get a prescription for an aperient from your doctor. Drink plenty of fluids and eat foods that will help (kiwifruit is good). We do have this article in he library:
    Constipation and stool softeners
     
  10. Momma-me

    Momma-me member

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    Yes, that was the price range. My plan is to just take good care of it and resell when I'm done with it. I think I can get my money back. (fingers crossed)
     
  11. Cynof4

    Cynof4 junior member
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    @Celle,

    Thanks for the advice. I am very concerned about post operative pain and that is why I am exploring all my options. Without explaining my entire surgical history :yikes:, suffice to say that I've been through a lot. I cannot take Milk of Magnesia, Miralax or Metamucil or anything with psyllium fiber. I can take Colace. That's it. I do eat a lot of veggies and high fiber foods in general. Hopefully, that will help!

    ~Cynthia
     
  12. Celle

    Celle FORUM ADVISOR Forum Advisor

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    There's another pain relieving device that might help you.
    I don't know if your surgeon uses it, but you could ask.

    It's called an On-Q and it continuously delivers local anaesthetic to your knee or to a large knee nerve for about 3 days. You can be discharged home with this in place and people who have had it report that it works well. The web site is here: https://avanospainmanagement.com/solutions/acute-pain/on-q-pain-relief-system/
     
  13. rosieNZ

    rosieNZ member

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    I may have been lucky with knee no 2 but I sure wasn't with TKR no 1. I was worried about opioids so restricted use.
    This time I just intended to follow Bonesmart philosphy and take em! I came home from hospital in pain/ discomfort, took meds and my husband hooked up Game Ready. It worked before the meds kicked in!! I thought "can this be real".My whole post op experience was enhanced. I wish I knew whether it was GR or just luck. If you asked my husband he would have no doubt!!! I hired mine and purchased an Aircast. By the time I was at the end of the 2 wk hire period I was using GR at most once a day. Aircast did not do as good a job (should have hired GR for 1 more wk).
    I felt I had more discomfort and took anti inflams and panadol regularly which I hadnr needed in week 2. BUT I was walking more. I still think GR is the star and my analgesic needs were significantly reduced. I may have been lucky?????
     
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  14. ulrich2000

    ulrich2000 junior member

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    There’s lots of techniques to do post op pain management for TKR. Did you speak with the anesthesia team to see what they offer.

    I had a combined spinal epidural, adductor canal blocks (femoral area), and IPACK blocks (popliteal nerve). The epidural came out post op day 1 - it needs to come out before the anticoagulant regimen. That was the general formula at the hospital I chose.

    Other places use straight spinal blocks with expatriate around the joint or in various nerve blocks.

    Good results can be had in any of these ways. Especially to help take care of the pain on day 1. When these wear off you will probably need to rely on some combination of opioids, Tylenol, IV and / or orsl NSAIDS (Toradol, Celebrex, Meloxicam, etc.) and ice.

    After day 1 things got worse for me for a couple of days, then better for a couple of days. The epidural and blocks wear off. Swelling increases. Remember I had both knees going on. It gets better.

    I tried to be brave one day in the hospital, refusing narcotics. I’ll tell you the soreness after PT and all else had me up all night. The next day I took whatever they offered scheduled and breakthrough. Much better. Then I slowed down on whatever made me sleepy. I ended up with mostly Tramadol. Tylenol and Celebrex as scheduled without fail.

    The constipation bit was augmented by the fact that it’s hard to get comfy to do your business when neither knee can bend without pain. That being said I have a history of bowel issues and refused most stimulants. Colace and “umm... sure, I’ll have the stewed prunes” along with deep breathing and a magazine lifted the embargo so to speak. TMI? Not among friends.

    Just my experience.
     
    Last edited: Apr 26, 2019
  15. Cynof4

    Cynof4 junior member
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    @Celle,
    On Q is definitely on the list of possible options. I used it when when I fractured my wrist and required surgery to fix it. It was wonderful!
     
  16. ulrich2000

    ulrich2000 junior member

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    @Momma-me
    This is for you too.

    I started using the Game Ready in the hospital. Ice was used up very quickly, as your legs are pretty warm from inflammation, and also because I was using a split tube set to do both legs simultaneously.

    The nurses would disconnect the tubings, take the unit to the bathroom, dump all the water, go get ice and fill the unit, add the right amount of water, and hook me back up. I felt sorry for them each time I needed more ice. My wife was not happy anticipating doing this at home several times a day for 2 weeks. We almost cancelled it but the surgeon said “this will be your best friend”. I trust him. It’s my knee but his work.

    Fast forward- we did this a couple of times at home. I brainstormed a better work flow. Way easier on the back and joints (wife had a recent anterior THR).
    Here goes:
    -find a spot for Game Ready to live
    -get a big mug which fits into the reservoir
    -get a big open pitcher (we are using our blender jar)
    -after your ice melts scoop out water with the mug filling the pitcher until down to the fill line.
    -dump the water in the kitchen sink
    -fill the pitcher with ice and dump into the Game Ready and start it up!

    This is way easier. No disconnecting hoses, power adapter etc.

    Also pillowcases wrapped around the legs help - more comfortable and it stops your legs from sweating between the cycles.

    This takes lots of ice. 4 bucks gets a lot of ice.

    The recommended settings from the vendor were
    5 days cold alone - program 1
    5 days cold plus mild compression - program 2
    5 days cold plus medium compression- program 3

    I’ m going to keep it till I feel it’s not really needed anymore.

    Good luck!
     
  17. Cynof4

    Cynof4 junior member
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    @rosieNZ,

    I’m hoping one of my Game Ready options comes through. I just got an email from their rep that said the self pay rate is $60 per day! That’s ridiculous. I might as well just buy one!Hopefully we can find an “introductory” rate that’s better. So discouraging..
     
  18. Cynof4

    Cynof4 junior member
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    @ulrich2000,
    You crack me up!!! I appreciate the real honest truth. :thankyou:

    Let me be perfectly clear. I do not plan to be a martyr. I’ve never been good at suffering in silence. I will take meds to be comfortable. I just want to know what the options are and make informed choices. I also don’t believe “that’s the way I usually/always do it” is what’s best for me. I want to be a part of the decision making about my body to the extent possible.

    I’m currently on the Celebrex, Tylenol and Tramadol (as needed) regimen now. I can live with that.

    My pre op class is in 3 weeks at the hospital. I know I’m having general anesthesia with blocks of some sort. I’ll see my OS one week later to ask last minute questions. I’d really rather have the Exparel, but I’m not sure how that discussion will go.

    Thanks for all the great advice!!!

    Cynthia
     
  19. tylermit

    tylermit junior member

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    I just had my experience with the On-Q system. Surgery on a Tuesday and the On-Q lasted until Saturday. It kept a steady numbness on the nerve group it was targeted at. Having done the femoral block and the On-Q I would do the On-Q . When the femoral block wears off be ready. It hit hard and fast and it took a bit of time to get the pain back in balance.
     
  20. Irish471

    Irish471 senior

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    My surgeon used the experal injection into the joint during surgery. My surgery was on a Monday and I stayed one night in the hospital. Honestly, pain control is given in multpile ways following surgery, so it’s hard to tell if relief came from experal and to what extent. I had a spinal, the experal injection, and different types of pain meds (oxycontin, oxycodone, tylenol). I know that when the spinal wore off, that’s when the real pain set in :oyvey:
     

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