Knee Surgery

[Turpentine21]

You should have a block done. The anesthesiologist can also do them preop.
The best way to reduce pain is to have Iovera done 2-4 weeks preoperative. Then, 30 minutes before the surgery have the anesthesiologist do a femoral (regional)block with exparel/bupivicane admixture. Alternatively, the surgeon can do a local block with exparel/admixture into the knee capsule, instead of the regional block. If using a local block, remind the doc to maximize the admixture volume to saturate the nervous. The exparel/bupivicane block should provide 2-3 days of great pain relief (pain score <5). The key is to have a multi modal strategy for pain meds. In this case, ibuprofen + Tylenol every 6 hours immediately after surgery. Don't wait for the block to wear off before starting the ibuprofen +Tylenol regimen. Also, don't take any opiods unless you have breakthrough pain. They will often prophylacticly start them in post op. Bad move IMO.

I appreciate the information and advice. My case and situation is a bit complicated. My doctor will not do a block beforehand. I do plan to ask him again in the hopes he may make an exception in my case. My wife asked him before he did hers but he just would not do it. I do know he has done them before but has not done them now for several years. I don't know why he is so against it. He is a very good surgeon but is set in his ways. I am not sure what he uses locally during the surgery. He did both of my wife's knees and she did very well. She's an RN and works at plus has insurance with the hospital where the doctor does surgery. We get a very big discount using him and by staying in house so to speak. So going out of house so to speak really isn't an option for me.

Unfortunately, I have been on pain management for 20 years now after breaking my back in a treestand accident. After 9 operations 11 of my vertebrae are fused with hardware. I can walk now but have a lot of nerve damage, muscle atrophy and spasms. I've been on meds for both chronic and break through pain plus meds for the spasms and inflammation since the accident. Without the meds I can barely get out of bed or function physically. We've tried everything. I've worked with the doctors to find the right combination of meds and just the right amount of them to allow me to get around and still be able to function mentally. I hate the meds. The doctors tell me they are amazed that I've been able to get down to the amount I take with the amount of damage that I have. Even with that the pain is still there but tolerable. I'd say 3 to 5 on the pain scale with the meds. With no meds I'm at 6-8. There's just nothing else they or I can do about it.

Right now I'm trying to dial back even further on the meds due to the upcoming surgery. I cannot take ibuprofen because I take Meloxicam every day.

I appreciate your advice as it gives me some points I need to discuss with my doctor.

 

[M77Fan]

I appreciate the information and advice. My case and situation is a bit complicated. My doctor will not do a block beforehand. I do plan to ask him again in the hopes he may make an exception in my case. My wife asked him before he did hers but he just would not do it. I do know he has done them before but has not done them now for several years. I don't know why he is so against it. He is a very good surgeon but is set in his ways. I am not sure what he uses locally during the surgery. He did both of my wife's knees and she did very well. She's an RN and works at plus has insurance with the hospital where the doctor does surgery. We get a very big discount using him and by staying in house so to speak. So going out of house so to speak really isn't an option for me.

Unfortunately, I have been on pain management for 20 years now after breaking my back in a treestand accident. After 9 operations 11 of my vertebrae are fused with hardware. I can walk now but have a lot of nerve damage, muscle atrophy and spasms. I've been on meds for both chronic and break through pain plus meds for the spasms and inflammation since the accident. Without the meds I can barely get out of bed or function physically. We've tried everything. I've worked with the doctors to find the right combination of meds and just the right amount of them to allow me to get around and still be able to function mentally. I hate the meds. The doctors tell me they are amazed that I've been able to get down to the amount I take with the amount of damage that I have. Even with that the pain is still there but tolerable. I'd say 3 to 5 on the pain scale with the meds. With no meds I'm at 6-8. There's just nothing else they or I can do about it.

Right now I'm trying to dial back even further on the meds due to the upcoming surgery. I cannot take ibuprofen because I take Meloxicam every day.

I appreciate your advice as it gives me some points I need to discuss with my doctor.

Turpentine, this discussion has brought up a point that might be worth a question when you talk to your doctor. There seem to be a variety of nerve blocks that are used. My brother-in-law just had a knee replaced, and is at a location where they have fancier medical facilities than I had access to here. He went home with what he said was a nerve block that was in the form of a device around his neck that delivered some pain med through a tiny catheter into his leg above his knee. I was not at all familiar with that as a take-it-home thing. When I had my knee replaced (and hips too) they gave me a nerve block associated with surgery prep. They said that these can last up to 3 days for some people. It didn't last long for me, maybe 4-5 hours total, but I am genetically resistant to painkillers. I do know that they can, and will dump some topical pain killer into the incision before they close stuff up. Maybe you could draw an anesthetist into that conversation. You clearly have a special case going on with your chronic back pain. It seems like every doctor has different training and different experiences with outcomes, so they all have different preferred methods. I heartily encourage a lot of dialog with your doctor - they work for you.

 

[Wolf76]

I appreciate the information and advice. My case and situation is a bit complicated. My doctor will not do a block beforehand. I do plan to ask him again in the hopes he may make an exception in my case. My wife asked him before he did hers but he just would not do it. I do know he has done them before but has not done them now for several years. I don't know why he is so against it. He is a very good surgeon but is set in his ways. I am not sure what he uses locally during the surgery. He did both of my wife's knees and she did very well. She's an RN and works at plus has insurance with the hospital where the doctor does surgery. We get a very big discount using him and by staying in house so to speak. So going out of house so to speak really isn't an option for me.

Unfortunately, I have been on pain management for 20 years now after breaking my back in a treestand accident. After 9 operations 11 of my vertebrae are fused with hardware. I can walk now but have a lot of nerve damage, muscle atrophy and spasms. I've been on meds for both chronic and break through pain plus meds for the spasms and inflammation since the accident. Without the meds I can barely get out of bed or function physically. We've tried everything. I've worked with the doctors to find the right combination of meds and just the right amount of them to allow me to get around and still be able to function mentally. I hate the meds. The doctors tell me they are amazed that I've been able to get down to the amount I take with the amount of damage that I have. Even with that the pain is still there but tolerable. I'd say 3 to 5 on the pain scale with the meds. With no meds I'm at 6-8. There's just nothing else they or I can do about it.

Right now I'm trying to dial back even further on the meds due to the upcoming surgery. I cannot take ibuprofen because I take Meloxicam every day.

I appreciate your advice as it gives me some points I need to discuss with my doctor.

A few thoughts.

Have you checked into a spinal cord stimulator for your chronic pain?

Your doctor doesn't need to do a block. The anesthesiologist can do a regional block (femoral block). I would strongly recommend not having surgery without a block. Frankly, I find it irresponsible to put people thru a ton of extra pain. The only guys that don't see the benefit are the ones that don't do then correctly. My job for the past 4 years is nerve blocks in the OR, so this is near and dear to me.
I know meloxicam (Mobic) very well... sold it to doctors for years.

See if you can find an Iovera doctor in your area. This procedure temporary shuts down nerves for 2-3 months. It's a non pharmacologic option that essentially uses hypothermia to inhibit pain signals. They target the genicular nerves (nerves around the knee). Kinda of like knocking out the radio tower... nothing gets transmitted.
Iovera.com
Good luck