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THR Worried about my post-op pain

DEL2021Apr-18

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I am having my THA very soon. I have a complicated medical history. I have been on long term opioid therapy, taking 20mg of Oxycodone daily. I have been on them since I had a couple of back surgeries a few years ago. Then more other surgeries after that. I had gotten my dose down to less than the 20mg's it is now though. I have been on now that dose for several months. I am very worried about post-op pain because long term opioid therapy patients going into any big orthopaedic surgery are a very challenging group for the the pain service to be able to manage given the big tolerance to pain meds.

I would like to hear from others who went into surgery on a fairly good size of narcotic like I am.

Also I have been given the choice between a spinal and whatever level of sedation I want with that (even none), or going full on general anaesthesia route. I have been told by every anaesthetist I have ever had run my case tell me it took them 2-3x the normal amount to put me under. One time I was told it was 400 of Propofol and 100 of Fentanyl and 1.5mcg/kg of Precedex. Part of me really wants to be awake for at least the first 20 minutes or so. Once the surgeon breaks out the bone saw to saw my femoral head off I think I want to go night night then. That can't be pleasant to hear. My surgeon does her hip's using the lateral approach so I will be positioned on my side.

To add to my issues. I have been in quite a few ICU's these last 4 years for various and really unpleasant reasons so now I suffer from "Complex Medical PTSD". Needless to say I am a bit anxious. Thanks!
 
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Pumpkln

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Welcome to BoneSmart, glad you joined us! :welome:
You do have some challenges going into hip replacement, you ask your surgeon about Exparel , a substance injected into the surgical site prior to closure, or about the On-Q pain ball for pain relief after surgery.
If you do not already have an ice machine or large ice packs for your hip, you may want to obtain them now. You can also ask if you will be issued an ice machine in the hospital.

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 hip, take a look at the posts and threads from other BoneSmarties provided in this link:
Stories of amazing hip recoveries
 
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Missy45

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Hi, I’m just about 6 days out of an anterior approach THR. I had not been on oxycodone prior to my surgery but have been taking Tylenol w/codeine as needed for over a year. I am prescribed 5mg oxycodone now, but have only had a few times that I really wanted to take it. Even then, I don’t think I would have made a call to the surgeon if I didn’t have it.

I have had back surgery too and deal with chronic pain from bulging discs. I will not say that the THR isn’t a challenge, it definitely is. However, intolerable pain hasn’t really been part of it for me. I have had migraines that have made me far more desperate for pain meds than I have been this week. The sorts of things I’m experiencing are best relieved with ice. Just thought I would chime in on that. I know that everyone is different, but hopefully this may help ease your mind a bit!
 

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Welcome to BoneSmart! I was one of the rare ones who woke up during my first THR. Unfortunately the anaesthetist wouldn't give me more sedation so I had to will myself back to sleep. But the experience was not pleasant. And if as you say you have PTSD - I would highly recommend you don't attempt to stay awake for any part of the procedure. It is very noisy "carpentry".
 
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Eman85

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Can't help you as far as the narcotics go, only experience I've had with them has been post THR's and didn't use much then. I do have a pretty high tolerance for pain so the THR pain was no big deal. Only time the THR pain got me was right after the surgery walk around the hall without taking anything for pain. As far as for the operation I went with the spinal and sedation. I'd never had it before and in previous operations always general. The spinal with sedation was a lot better. With my first I was sedated before they rolled me from pre-op, with the second I was awake while they positioned me on the table, that's the last I remember. Ice is the greatest thing post op more than pain meds. Ice give great pain relief and also relieves the swelling and the bruising.
Many years ago I woke up and sat up on the operating table during an orthopedic procedure while under general.
 

djklaugh

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You do have a complex situation! Do you have a specific doctor or clinic that helps you manage your chronic pain? If yes perhaps he/they could (and IMO should) consult with your surgeon about managing your pain both before and after hip replacement. Also have you ever used a TENS unit for pain management? That might help your back pain though I don't know how it would do for post op pain. Are there other things besides pain medication that you've tried? Acupuncture? Hypnosis?

As for the "complex medical PTSD" -- I can certainly understand how that would add to your anxiety! Have you in the past or currently seen a therapist - one who has a specialty in this area? If you have or are seeing such a therapist now would be a good time to talk about the upcoming procedure. If you have not seen someone then perhaps your pain management providers can help you find someone.

Best wishes to you through this process!
 
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DEL2021Apr-18

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You do have a complex situation! Do you have a specific doctor or clinic that helps you manage your chronic pain? If yes perhaps he/they could (and IMO should) consult with your surgeon about managing your pain both before and after hip replacement. Also have you ever used a TENS unit for pain management? That might help your back pain though I don't know how it would do for post op pain. Are there other things besides pain medication that you've tried? Acupuncture? Hypnosis?

As for the "complex medical PTSD" -- I can certainly understand how that would add to your anxiety! Have you in the past or currently seen a therapist - one who has a specialty in this area? If you have or are seeing such a therapist now would be a good time to talk about the upcoming procedure. If you have not seen someone then perhaps your pain management providers can help you find someone.

Best wishes to you through this process!

My PCP manages my pain meds and I am lucky I have not had any problems getting all the meds I need. I am seeing a clinical psychologist who specialises in trauma. She has worked with a lot of patients like myself too. We have been talking about this surgery every time i see her. I am in good hands with her. It is exceptionally difficult for me. The stress of knowing exactly what they have to do to get a joint replacement. I made the mistake of watching this procedure on you tube in very graphic real OR footage :(
 
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FCBayern

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I made the mistake of watching this procedure on you tube in very graphic real OR footage :(
I can understand how that made you feel about joint replacement. I watched a video of ankle replacement after I had it, pretty graphic stuff. Amazing how much orthopedic surgery is like carpentry! Hammers, saws, drills, holy :censored:. But in reality it's all the soft tissues around the joint that are so upset after surgery. The bone never hurt in any of my replacement joints, quite the opposite, the grinding pain in those joints was gone!
 
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Mojo333

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I'm very glad I stayed pretty ignorant of the process prior to my BTHR. :unsure:
Post-op, I checked out an animated version of the procedure along with some pics of the Hanna table used for my surgery:flabber:

Staying focused on living a hip pain free life and getting back to my physical job and weekend hobbies really kept me from getting as anxious as I could've been.
I was such and tired of being in pain and tired...and feeling old.
Hip happy now.:chuckmarch:
 
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DEL2021Apr-18

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Thanks for all the support and replies. Yes I need to try to focus on feeling better and getting back to life. Having PTSD and then having the extra emotional ravaging effects of steroids make this almost an impossible task but I am trying. I went for pre-op today. Where I go has 2 pre-ops clinics. The main one for 95% of the people they operate on, and then the one I went to is designated the "high risk" pre-op assessment clinic.
I was interviewed by an anaesthesiologist. She was very nice and said I definitely had a lot going on for them to evaluate. Despite my surgeon saying she does all these with a spinal she said ultimately it is up to the me and the attending anaesthesiologist to determine the best/safest approach. She was strongly recommending I have general anesthesia even though that is not their norm for this. She was afraid with just a spinal, and even heavy sedation added, that due to my high tolerance to all these meds (including propofol) I would hear all the noises, be triggered and become violent then they would be forced to convert this to GA in the middle of the procedure which is really something they try very hard to avoid for a number of reasons I won't list.
I have a history of violent emergence delirium so even under a lot of meds I have proven to become so aggressive in the PACU they have had to use, both chemical, and then when that failed, they have had to use physical restraints. They say this is all tied directly to my PTSD and do not blame me. In the OR I have become violent as well when a conscious sedation approach has been tried on more minor procedures . I have no recall of any of these multiple episodes of violence that stretch over the course of several years now other than waking up eventually sometimes wondering why the hell they have me tied down.

So I have a lot to contemplate. Having said all that I am still on the fence and considering using the spinal+sedation route. My psychologist thinks that is a bad idea but said of course it is my decision either way. We shall see. lol
 
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Mojo333

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Good morning
My surgeon decided my surgery would be performed under general anesthesia...perhaps because I was undergoing bilateral hip replacement :shrug: and I didn't have the medical knowledge or understanding there could be another choice.
I'm glad I was "not there" for any of it...and did fine in recovery. I was slightly nauseous but not for very long and never got sick.

If I was your surgeon...I'd insist on putting you out for my own safety.:heehee:
But seriously, you wouldn't want to wake up in a violent state while they are getting that new hip in. I'd go with GA.

For all the help you have given to others in your line of work...you deserve a good hip pain free life. This surgery is not a punishment. It is a true blessing.
I am a director of a food bank and have an extremely physical job especially this past year with curbside distribution and my new hips have been a godsend.
 
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