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October 30 surgery...Pre-surgery appointment today...Discharge plan includes PCA Pump

tlfiore

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Hi everyone. First, I want to express my gratitude to the wonderful folks here on BoneSmart who take the time to post and help others. Locating this website has been a God-send for me and I am grateful. Thank you!

I have read and learned SO MUCH already from everyone. I know I will be here on the forums a lot!

So, I just returned from my Pre-Operative Surgical & Anesthesia Evaluation for my right TKR, which is in two weeks on October 30th. I am a Nurse Practitioner (semi-retired); however my specialty is not Orthopedics. I was literally shocked when the Nurse Practitioner I met with told me, "I would be having a saphenous (likely) nerve catheter temporarily placed prior to surgery, as my hospital and surgeon's is to discharge people with a Patient Controlled Pump, or Patient Controlled Analgesia for 3-4 days of post-surgical nerve block/anesthetic." This method is apparently favored in lieu of moderate oral narcotic use for post-TKR pain management.

I guess one favorite device is the "On-Q Pain Buster," or "On-Q Infusion Pain Pump." Wow...I haven't seen/heard/read anything about this and I am really surprised.

Has anyone heard of this measure as an alternative for TKR post-surgical pain?

Scouring for information right now!
 
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jeffjob

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Wow, no I have not and I had my TKR's done at a fairly progressing center in Connecticut.

Very well could be more driven by the Opioid issues here in the states.

I suppose it could work well but couldn't there be issues with the nerve block and leg / lower body functions?

I had nerve blocks, a spinal and propofol. The nerve blocks we done with ultrasound (4 injections in each upper thigh) so they would closley target the right nerve.

Sorry I don't have information on it being used, hope my thoughts help.
 
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tlfiore

tlfiore

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@jeffjob thank you so much for taking the time to reply to my very first BoneSmart post! As an aside, in my former "first" life, following Graduate School in New Jersey (many years ago), I worked/lived in the Hartford area for a few years and later moved to Durham CT, the Greater New Haven area. I worked all around...Waterbury, New Haven, Bridgeport, etc because I lived in Connecticut from mid-1983 to 1993, or so. I also worked at the original Connecticut Hospice in Branford CT for years. I love Connecticut but after my divorce, I decided to move to Manhattan!

So, apologies for my digression; however I know the Connecticut health care systems very very well and yes...most are extremely progressive! Connecticut has some of the best health care in the USA.

Not sure what's going on with this analgesic pump but I'm certainly willing to try it. Yes, apparently some leg weakness, some muscle reaction, etc are possibilities. And of course, there is the usual plethora of potentially deadly side effects.

But I'm told the catheter placement at the "saphenous" never (versus the femoral nerve) makes a difference in lower extremity weakness, as does dosage, administration times, etc, etc, etc.

So, we shall see, right? It will be interesting.

And yes...your thoughts have helped TREMENDOUSLY!

Thanks again for taking the time to post.
 

Jamie

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Hi, @tlfiore ... welcome to BoneSmart and congratulations on your upcoming surgery. You're going to do great! And we'll be here to help you with any questions or concerns you may have.

The On-Q pain management system has been around for awhile (it's not "new") and it has proven to be an effective pain management tool. There are a number of things that surgeons can do today to help with post-op pain and reduce the amount of opioid pain medication needed to get through those first critical weeks after surgery. Great strides have been made in the past few years to the point where many patients can come home and use Extra Strength Tylenol and Tramadol for their pain management. Some even just use the Tylenol.

I'm sure I don't have to tell you that internet searches can bring up a lot of scary "information." Please take the things you read there with a grain of salt (except for what you read here on BoneSmart, of course! :thumb:)

Everyone's recovery is their own and there is no way to know exactly what yours will look like until you're there. You should have a great start with the On-Q, though.

Here are some pre-op articles to get you started planning and thinking about life with your new knee:

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?


And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

Stories of amazing knee recoveries
 
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tlfiore

tlfiore

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@Jamie you are so kind...thank you for the helpful information and all the links. I feel MUCH relieved after reading your feedback about the pump. You are obviously a very kind and knowledgeable woman, so your opinion matters a lot.

I have definitely been reading all the information provided here and I am grateful. I purchased an "Aircast CryoCuff" for icing (the pre-surgical team gave that the thumbs-down...needless too say, the team was a bit annoying today-smile...I'll follow their lead and use the CryoCuff anyhow). I also have a Lounge Doctor coming...a few other things.

I will definitely be out here a whole lot. This Forum is fantastic support.

Thank you!
 

Jamie

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You mean they didn't want you icing after surgery or they just didn't like that brand? If it's the former, you're just going to have to practice smiling sweetly, nodding your head and then doing what you know is best. The CryoCuff should work well for you.

I look forward to hearing how you do with the On-Q. It's been a while since we've had a member who used one. But I cannot recall anyone who ever had a problem with them and the pain relief is real.
 
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tlfiore

tlfiore

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@Jamie thank you. They did not speak highly of the CryoCuff. NP rattled off some "patient complications" with it in the past. I barely listened. NP said, "Discuss it with your surgeon, blah, blah."

You are so correct about nodding, saying "uh-huh...I get it" and doing what is best for me and my body.

I found these pre-surgical folks to be a bit overwhelming today. Humorless, like robotic fact-delivery machines. I felt like I was just in some meaningless assembly line. I must have looked down-trodden when I entered the elevator because a nurse who got on with me said, "Not a good day?" I said, "Errrr, ummmmm...just a bit overwhelmed with pre-surgical knee stuff...I feel as if I just stepped off an assembly line." Nurse replied, "Welcome to medical care 2019."

But it's all good! I did gather some very useful & helpful information from the team.
 

lovetocookandsew

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I had an On-Q style pain ball for my revision and it worked wonderfully well. The only down side to them, IME, is they only last about 3 days so need to be replaced at that point, and they will only let patients have one or two. In my case after the second one emptied, I was miraculously in very little pain, so icing and elevating was all I needed after that. My hope is that one day that's the pain relief of choice for doctors after this surgery and that they allow patients more time if needed.
 

Jamie

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@tlfiore .... no worries about the "assembly line." We are definitely NOT that here at BoneSmart and we'll always be here for you. Here's hoping we can get you feeling a bit more comfortable about what's coming up soon. Knowledge is power and we have the experience of many, many BoneSmarties at your fingertips here.
 
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tlfiore

tlfiore

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@lovetocookandsew thank you for taking the time to post about your experience. Hearing from someone who actually had one of these pumps is very comforting. I'm so glad it worked well for you! Yes, I imagine IF the powers-that-be decide I do need the anesthesia beyond 3 days, I'll have to deal with a replacement. The NP did indicate "the pump is essentially used for 3-4 days."

So we shall see. I like to believe I am direct, honest and forthcoming; however, in reality I'm not so sure I am on a consistent basis. SPEAKING UP about pain is going to be a huge thing for me.

Thanks again for posting. I hope you are well.
 
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tlfiore

tlfiore

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@Jamie I can tell the folks here...Administrators, contributors, members...are all extremely patient and very kind. It's difficult for me to speak up, especially if I fear hurting someone, or going against the grain (status quo).

Gotta give it a try this time and speak up with these health care folks-smile!!

Thanks again, Jamie.
 

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