need knowlwdge re knee surg

[TopazLover, BSN, RN]

Hi, I am not ever involved in ortho surg. so am not up to date. My DH is having a hemi knee done soon. He currently takes oxycontin for pain. His Family doc. will withdraw him over time after the surg. My husband is concerned about the acute pain post op.

I would like to know the usual course of events. The doctor is one I don't know except by reputation and the surgery will be done in another town. We have tried to call the office and get questions answered but the "nursing staff" (I am not sure if she was even a nurse) only wanted to tell him to quit the pain med now, seems stupid to give medical advice when you don't know the situation. The info they sent was about a full knee replacement. I do know there are differences in recovery.

Facts from someone would be helpful to me. I am just the worried wife.

I don't want you to give medical advice, just the usual course.

Thanks,

[Tweety, BSN, RN]

Exchange of ideas, experiences, and support is welcomed just as long as no medical advice is given.

If someone needs pain medicine to function why on earth would anyone recommend stopping it? Most patients continue to take their pain medicines up to the time of surgery.

The usual course post-op is morphine for the acute pain for a day or two and then a switch to p.o. meds. He may need higher doses at frequent intervals because of an opiod tolerance, but his pain should be controlled. Definitely he should be expressing his concerns to his MD and together they should come up with a plan.

But if a pre-op conference can't be done, then definitely post-op if his pain is uncontrolled encourage him to speak up. He's going to have pain, and probably won't be pain-free, but he shouldn't be in agony. He should have reasonable comfort.

[nightmare, RN]

One of my work colleagues was told to stop taking Diclofenic before her op so she also had to stop work early as she couldn't work without the Diclofenic.Something to do with blood thinning IIRC.

[TopazLover, BSN, RN]

He stopped his usual ASA and Motrin because of the possibility of bleeding. I appreciate your quick response. Thanks

[NRSKarenRN, BSN, RN]

agree with tweety's comments re pain management. one of the most important things to tell nurses/doctors at preoperative assessment is the total amount of oxycontin one takes in a day so adequate postoperative pain management can be provided.

i process about 20 referrals for homecare for patients having undergone hemi or total knee replacements... this great article highlights care i see doctors provide in philadelphia area.

knee replacement surgery - treatment of arthritis with knee ...

most patients have 2-3 day hospitalization, are then sent home with homecare rn and pt (physical therapy) for 2-3 weeks then go to outpatient center. if other significant medical problems, patients ocassionly go to skilled nursing facility then home.

most common pain med postoperatively is oxycontin. we tell patients to take it especially 30-45 minutes before the therapist comes to the home and evenly spaced out do age while awake to decrease pain and promote one moving about the home. most patients find after a few weeks, they slowly are able to decrease dose as not having that !!!xxx!!! grrrrr pain any longer.

good luck with upcoming surgery. wishing him better days ahead.

[NJLaurenRN]

they say that knees are the most painful surgery one can have. but you get thru it and its worth it in the end. he should talk to his doc pre-op and with anesthesia. in my hosptal we do alot of spinal anesthesia and usually with these patients the anesthesiologist can put in an epidural PCA (usuallly with fentanyl and bupivicane with a contiuous and PCA mode) my patients seem to have positive results with this. also some docs do a femoral block which helps relieve pain for the operative day. we also do a lot of MS PCA's and then by POD#2 switch to PO (like a scheduled Q12hr oxycontin and percocet for breakthru Q4h) i agree with the other comments it is very important to premedicate before PT. he will be able to have a better PT session. pain is inevitable but having a good pain management regimine is crutial to a speedy recovery. also look into getting a polar care system. alot of insurances esp medicare won't cover them entirely or sometimes at all. polar care is a unit that wraps a pad around the knee with tubes attached to a cooler with ice and water. its a constant cooling machine. in my opinion pts with them vs. pt with out them have significantly less pain and swelling. best of luck. be sure to push him and encorage him thru out his therapy. coaching helps also. be his support and his coach. once again best of luck

[loricatus]

Ask your husband's doc about him getting a pain pump for the first few post=up days. The one I am familiar with is called On-Q. Having the meds go directly into the surgical site greatly reduces the need for narcotics & helps overcome the problems of tolerance your husband has probably developed.

[TopazLover, BSN, RN]

Thank you all for your thoughtful responses. We spent much of Friday flying to the hospital where his surg. is scheduled Mon. I will be the determined wife and nurse-coach for him. Keep us in your thoughts Mon. and I'll let you know how things go.:redpinkhe

[sirI, MSN, APRN, NP]

Good luck. We hope for an uneventful surgery, adequate pain-control, and a successful rehabilitation.

[TopazLover, BSN, RN]

Update to all who have helped, Thanks to all of you I felt more prepared and DH had surg. So far good pain control with PCA Morphine and the Polar Cap. He was able to dangle by 6 pm. (went to OR@noon,out of Rec just before 4pm.)

I appreciate your "ears" through this time. Thanks again.

[loricatus]

So glad to hear that everything is going well.

[sirI, MSN, APRN, NP]

That's great news. Hope he continues to do well.