Presurgery Appt

[Linda2]

I had my presurgery appointment yesterday. Now I'm concerned about anesthesia choices--spinal v. general. I also found out my surgeon is one of those who thinks I probably won't need outpatient PT. Thanks to you guys (and my previous good experiences with PT), I gently suggested that I would probably want it. He seemed fine with that, so I'll cross that bridge after I cross the surgery bridge! I am increasingly nervous as it gets closer.

 

[carolinagirl]

Hi Linda,

I am 3 weeks post-op right TKR. I had general anesthesia with a femoral block. i was offered the option of epidural or general and I chose general.
I prefer to be as out of it as possible. The femoral block really worked for me.
My surgery was Thursday July 3 and the block came out on the 4th day.
You will find that some of us on here prefer the epidural while others general.
It is really all a matter of what you are comfortable with.
Best of luck to you on your surgery.

 

[Josephine]

Good reply, Carolina, but don't forget that spinal doesn't necessarily mean being awake. Most anaesthetists will give a sedation which gives patients the same effect (from their point of view) as a general. But you still have the benefit of complete pain control in the immediate post op period.

 

[Linda2]

Actually, the doctor said spinal, not epidural--they are different, right? He also mentioned the femoral nerve block, but only as an alternative if standard pain medication didn't work. His take on it is that it is great for pain, not so great for early pt.

 

[Josephine]

No difference so far as you are concerned. Just a different technique. Early pt will not be so crucial as good pain control.

 

[AlaskanTKR]

Linda
I had my surgery 7/14. General Anesthia with Femerol(??) Nerve Block. Nerve block was awesome until it wore off. I als had the pain pump thing. The nerve block was sooo great. No pain. But oh my - it wore off at 12:30 AM and I though I was having contractions in my knee (like having a baby). Once we got some flexiril for muscles spasms and oxycotin going in combination with the pump all was well.

Outpatient pt??? You mean like physical therapy when you go home?? I cannot imagine having this without it. I had PT for 3 of my 4 scopes just to increase strength and limit the opportunity for scar tissue to form. I have been trekking out to PT this past week and what a difference it makes. I have tons of swelling and it is really helping me to work on the flexion (we hit 65 with lots of pushing). In all honesty I really hate going becuase he really makes me bend that new knee and it just feels so tight, but the alternative would be awful.

Hope all goes well. I was emailing the same day as my surgery thanks to the nerve block! Hang in there and let us know how you are!

Marianne

 

[Linda2]

No difference so far as you are concerned. Just a different technique. Early pt will not be so crucial as good pain control.

I don't quite understand this. I thought that a spinal involved injections to a certain part of the spinal area that lasted for however long and then wore off, and an epidural is a catheter placed in a slightly different area that remained in for a longer period of time and through which additional medication could be delivered? Therefore, I didn't think there would be pain control benefits from the spinal for an extended period. I'm confused. (And becoming more terrified daily!)

 

[JudyS]

Linda,
I am probably confused now too. But, don't be terrified. I had my hip replaced 7 weeks ago.
The anesthesiologist gave me one or the other in my back and explained that he could then use a lighter anesthetic. All I know is once the relaxation med kicked in, I don't remember anything until I was well in my room in the evening. My spinal/epidural(whatever it was) he said gets one dose before surgery and one after and would last a total of 12 hours.

Most of all, don't be terrified. It will be fine.
Judy

 

[beachcomber]

Linda,

I had the spinal/epidural option for my PKR in December. I highly recommend it. I was stressed (more about work issues than the surgery) when I talked to the anesthesiologist in the pre-op area and he asked if I would like something to help me relax. I said "Yes". He added something (Versed) to my IV and I remember telling Scott I could feel it taking effect. I sort of remember being wheeled out of the little room past the nurse's desk. The next thing I knew I was in my regular hospital room hours later and in absolutely NO pain. I was given the option of leaving the epidural in for an additional 12 or so hrs and I said yes. It was excellent pain control. Then they switched me to IV pain control and then to oral meds and I went home.

And here is a bonus some may appreciate--- someone popped into my room that first evening and introduced himself as the PT and said he would soon be my worst enemy. But we both got a reprieve because of the epidural and I didn't have to start PT until the 3rd day. And it was a different PT and I hated her! LOL!

 

[Josephine]

I don't quite understand this. I thought that a spinal involved injections to a certain part of the spinal area that lasted for however long and then wore off, and an epidural is a catheter placed in a slightly different area that remained in for a longer period of time and through which additional medication could be delivered? Therefore, I didn't think there would be pain control benefits from the spinal for an extended period. I'm confused. (And becoming more terrified daily!)

Spinal anaesthesia involves puncturing the dura, the fibrous covering of the spinal cord, introducing anaesthetic into the fluid bathing the spinal cord.

An Epidural does not puncture the dura; the anaesthetic is introduced outside the dura, so it bathes the nerves coming off the spinal cord.

An epidural catheter is an optional extra. Of course, if a catheter is used then top-ups can be given during and after the procedure which is what you are referring to but it's not an across the board practice. It depends upon the circumstances, the doctor's training and the local custom and practice - for instance, whilst they appear to be in common use in the US, they not so commonly used in the UK.

Both spinals and epidurals last about 2-4 hours anyway so none of this actually matters for you as the overall effects and results are exactly the same.

There is actually a procedure called CSEA (combined spinal-epidural anesthesia) which is sometimes used in obstetrics though I don't know under what circumstances.

 

[Linda2]

Thanks Josephine--I knew there was some kind of difference. I think the epidural catheter must be quite common here in the states. I have not known anyone personally who did not have a catheter with an epidural--but I'm no professional and my experiences are limited.

 

[ttlncsc]

Hello Linda,

I am a little over 5 weeks post op rt. Knee replacement. Due to my medical background, I looked at anesthesia based on my experiences. I opted for a spinal. I do not remember getting the spinal, nor the prep, nor the catheter insertion. They snow you with great happy drugs and that take away most of your memory. My hospital experiences in the recovery room showed most of the patient complaints were related to a sore throat from the tube they insert between your vocal cords when you are put to sleep. That was a major factor in my decision.

My surgeon utilized a pain control pump, pain pills, and a nerve block pump. While there was a delay in getting foot movement from the spinal, I was fairly comfortable for the first 24 hours. I knew going in that the first night might be my best shot at a fairly comfortable sleep. The next nights were not as restful and the 3rd day post op was my worst. The 3rd day was when my pca pump and nerve block pump were removed. Most agree that the better you stay on top of the pain the better. Don't try to tough it out....the knee will win.
Hope this helps. Tom

 

[Linda2]

It helps a lot! After doing a bit of research on my own, I too will opt for the spinal if I can. It seems to be the recommended way for diabetics (which I am), and after a total of 7 previous surgeries in my life, I know I don't like the "out of it" feeling that general anesthesia gives me after surgery. The one time I had a local with Versed, I remember everything that happened--the amnesia part didn't work so well with me. Still, I think the going under thing is frightening, so at this point I'm leaning toward the spinal.

Thanks so much for the additional info.