TKR Snow storm, nerve block and some suggestions

[Katrina’stkr]

So I’m home from overnight. This is LTKR right was done some time ago. First, my surgery was on worst day of 3 day blizzard, previous 2 days surgeons cancelled their caseload, mine not cancelled so kudos to staff !
I had a pain meeting with PA last week, she explained toes tingling means nerve block running out and to take pain meds right away. I was able to write a schedule and show her I would run out over weekend so she gave an increase in the script.
I walkered to the bathroom in recovery, no problem. A half hour later, toes tingling. Bathroom again and so painful they had to get a wheelchair. I had the block at 9am, surgery start 9:30, block wore off 3 pm, 6 hours. Nurse skeptical in recovery saying to overnight nurse she “thinks” nerve block ran out” my last one was about 29 hours nerve block.
Otherwise, programmable ice machine is a must. I brought a sleep mask for overnight stay which was a lifesaver, great sleep compared to last time.
I wanted my husband to go to surgery center this am and talk to them about another nerve block so I’m not popping oxy, recovery nurse said they won’t do it, sometimes blocks just run out early. My suggestion is to watch for tingling toes and then pain meds right away.
I had good luck with surgery despite weather and challenge with pain block but otherwise doing well. Zzzzz

 

[sistersinhim]

Welcome to Bonesmart for your second TKR. My nerve block ran out quickly, too, but they gave me 10mg of Oxy, which really helped bring the pain down to about a 5 unless I moved. Ouch then! They kept the ice coming, but with all the bandages, it was hard to feel it. Once I got home I ran my ice water circulating machine. Ahh...much better!

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy

5. At week 4 and after you should follow this
Activity progression for TKRs

6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here

Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep

 

[Flashlight]

Hi, my nerve block only lasted about 10 hours. I think I overheard the anesthesiologist remark that I had small veins. I do know he gave me the nerve block after surgery and that he tried twice. When I walked to the bathroom while in recovery, I had those pins and needles sensation in my feet from the spinal wearing off. I started taking the oxy routinely that evening with the other medications that were ordered. By morning it was pretty clear the 10mg of oxy was not controlling my pain. My doctor changed my prescription to dilaudid. Good luck in your recovery.

 

[Katrina’stkr]

SIH and flashlight, thanks for letting me know about your block running out early, validation helps ! I have 10 mgs oxy every 4 hours.
SIM do you remember how you titrated down after that ? Meaning 2 every 5-6 hours or 1 every 4 hours ?

 

[benne68]

Are you taking Tylenol, @Katrina’stkr ? I found it to be a huge help as I started to wean off the Oxy. But you have to take it correctly for it to help.

You can take 2 extra strength tables (500 mg each) every six hours (4 times a day) -- as long as none of your other medications contain acetaminophen because it's important not to exceed 4000 mgs/day.

The key is to stay ahead of the pain by taking them on schedule. If you skip a dose or try to stretch out the doses too much, the pain will get worse and it will take several cycles to get back to a manageable level.

Once you get onto a regular schedule with the Tylenol, you can save the Oxy for bedtime or for breakthrough pain episodes.

I know sisterinhim provided this link in the information above, but if you haven't already read the article, I think you will find this helpful: https://bonesmart.org/forum/threads...ing-pain-after-a-tkr-and-the-pain-chart.7969/

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[Katrina’stkr]

Yes I am taking Tylenol 4x day 1000 mgs also meloxican, hydroxezine Tried to decrease oxy over night and got behind the pain. 55 hours out now as I write. Programmed Ice machine and elevating. Very very slow walking to bathroom, really painful without using a leg lift stick even to sit down from standing. This is much slower than first tkr. Hoping I’ll start to improve tomorrow. Due to nerve block running out so soon I will need to call in for additional reinforcements tomorrow.

 

[Layla]

Happy One Month Anniversary!
How is recovery coming along for you? I hope your pain has eased significantly and you're enjoying steady progress.
Have a wonderful Spring 2023!
@Katrina’stkr