Total Knee Surgery

Charity, RN, APRN · Jun 26, 2005

We do the femoral nerve blocks in our unit all the time. My suggestion is to make sure that it is done:

A: preoperatively, so that the infusion can be started immediately post-op in the pacu,

B: that you ask for Versed or another sedative during the procedure.

C: A sciatic nerve block (one time injection given in the OR) will help enormously as well.

Femoral blocks do help, but only with the anterior portion of the leg. The sciatic block would help with the posterior aspect.

Most of my patients tolerate the insertion fine, but the ones that do really well have had sedation. The electric current used to locate the femoral nerve is what bothers them. If done pre-op, they don't remember. Thank God for amnesiac drugs!! I can't speak to the long-term effeciacy of them, as I work in a PACU, not on an ortho floor. But I do know we ARE doing a lot more of them. Hope this helps.

C

dosamigos76, RN · Jun 26, 2005

I don't know about the femoral block, but I work on the surgical floor and we do LOTS of TKA. Every patient I've ever had says that they wish they had had the procedure done sooner. We usually use PCA's for the first 24 hours, up the day following the surgery and out by the third day. Let us know how things go for you and best of luck.

Cheryl

kmchugh · Jun 26, 2005

Have done a lot of these as a CRNA. Have not done a femoral block for one, but have seen it done. My question for you is are they planning to insert a femoral cath for continuous block after the procedure, or are they doing a one shot deal? A continuous infusion for about 24 hours post op (have not seen this done, but have heard of it) will give you great pain management through the day after surgery. As an added bonus, the femoral cath will allow you to be put in a CPM machine and often they can immediately start you out on 90 degree flexion. Reduces the need later for return to the OR to have to break adhesions under anesthesia.

Sometime in the not too distant future, I will have to have a right TKA. My anesthetic plan for the procedure is to have a CSE (combined spinal/epidural) done. The spinal will be for the actual surgery, with epidural placed for pain management afterwards. And no, I don't really plan on giving the orthopod much say in this matter. I've seen the benefit of epidural management over and over for TKA, and have decided that's what I want done.

Kevin McHugh, CRNA

Euskadi1946 · Jun 26, 2005

Hi, I am 54 years old & have been a nurse for 33 years. In August I'm having a left total knee done. Since I haven't worked orthopedics for years I'd appreciate any info that anyone can give me about the surgery, post op recovery etc. The doc said I'll probably be off work for 3 months. Also he'd like me to have a Femerol Nerve Block for pain control during & after surgery. I am chicken when it comes to someone putting a Large needle in my groin to do the nerve block. Has anyone seen this done? Thanks so much for your help.

I had a total knee replacement on my right knee 5 years ago at 53 years of age and it was the best thing I ever did. My orthopod told me I was one of his youngest patients. They got me up 8 hours after surgery and even though I had some pain after surgery, the pain in my knee was gone. What was rough was the physical therapy I had for 2 mos post op. I was also scared but I had a fantastic surgeon and anesthesiologist and the staff on the ortho floor was great. I will probably need to have the other knee done in a couple years but I would go through it 100 times again to be rid of the pain I was suffering in my knee.

coffeentea · Jun 26, 2005

how about an epidural? at the hospital where I work most of the doctors use epidural for total knee & total hip replacement the patient are usually very comfortable coming out of surgery. even better if the drip is started in the or. Good luck

barefootlady, ADN, RN · Jun 26, 2005

I only know hubby woke up in pain but was so happy to get his, he also wished he had it done sooner. Recovery is slow, be sure to do all of the exercises. Women here seem to be more aggressive in their rehab than the men.

BackOff · Jul 2, 2005

I worked for a large group of orthopedic surgeons as their administrative nurse. Average total joints done was 5-10 daily. The three months off work is flexible, depending on what you do. If you are a nurse who does mostly paperwork instead of patient care, you may be able to return to work sooner. You can usually drive in six weeks. sooner if it is a left TKA. Do use epidural for pain control , it does make a difference. You should be out of bed about 12 hours after your surgery. That evening if am surgery, the next am if late in the evening. You should do well. Good luck

TracyB,RN, RN · Jul 4, 2005

I used to work Physical Rehab & the biggest "mistake" I saw was pts not taking pain meds before starting on the CPM. Take your pain meds & do your exercises religiously.

I agree with Charity about the blocks...