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What would you recommend for Pain Control for ACI/TTT?

Epidural
3 (27.3%)
Nerve Block
4 (36.4%)
Other
4 (36.4%)

Total Members Voted: 11


Author Topic: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?  (Read 9503 times)

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Offline Chondrosoldier

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Looking at a 2-3 day hospital stay, never had an Epidural.  The crash after nerve block following last ACI and TTT (done separately) has been brutal, even with the morphine.  Know a lot of the regular posters have had differing experiences.  Have a TTT/multiple lesion ACI implant next Wednesday.  Leery of having a large needle stuck in my back for two days but want to get all possible feedback.  Thanks!
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant
Happiness!

Offline kr8ivemind

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #1 on: March 31, 2008, 10:12:47 PM »
I just saw my doctor this morning and scheduled an HTO. He does not do any nerve blocks. He told me that there can be complications with them and when they wear off, you'll be in just as much pain as if you didn't have them. He also said the nurses in recovery can manage your pain better when a nerve block is not given. Back in December, my sister had a TKR done. They gve her an epidural. She had a reaction to it and ended up in ICU.

However, everyone reacts differently.
Denver, CO
8/99 - ACL recon, pretty much trashed now with severe OA (RK)
3/07 - scoped and medial meniscectomy (removed 75%) (LK)
10/07 - Hyalonic injections,no relief, moderate OA in medial compartment (LK)
5/15/08 - HTO (LK)
8/6/09 - HTO Hardware Removal (LK)

Offline MegTX

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #2 on: March 31, 2008, 10:17:44 PM »
Interesting experiences... I didn't have an epidural for my knee, had a nerve block.  Had horrendous pain in recovery, took quite a bit of morphine to get it under control, and then day 2 at home when the nerve block wore off was sheer hell.  I was technically overdosing the vicodin to make it through (don't get too concerned, I was taking the 10 mg every 4, and bolstering it with an additional 5 mg in between) those 2 days after the nerve block wore off.  Now I'm wondering if the nerve block helped or hurt.

My only epidural experience was childbirth, and I'd not have had it any other way.  ;-)
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

Offline David3

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #3 on: March 31, 2008, 11:10:43 PM »
I had an epidural for my ACI / TTO.  I was really happy with pain control and would do exactly the same again.

My surgery lasted over 3 hours due to multiple lesions. The anesthesiologist said I could have a sedative in addition to the epidural, but I just never needed it. I was awake and fully conscious during the whole surgery, at one point listening to the OS's progress that he described to me.

Pain control afterwards was also very good - pain level was a very tolerable 3/10 for the first 48 hours or so, after which I went on to oral medication which also worked well.  Doubt if I'm either more or less 'tough' than anybody else on this site - just happened that epidural really worked well for me.

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline djs60

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #4 on: March 31, 2008, 11:15:36 PM »
I had an epidural, and it was fine for pain control.

The advantage was also that the epidural was put in in the holding area, so I did not need general anesthesia for the surgery.  I was pretty snowed, though; I really don't remember anything about the surgery (TTT/aci of patella & trochlea).

I did have one difficult moment in the recovery area post op where the catheter got kinked or slightly pulled off center.  Consequently, my right leg (the good one) remained numb, but suddenly I could feel 10/10 pain in the left.  They got that sorted out quickly, though.

With the epidural, I had a little button gizmo where I pushed it when I wanted & got bits of dilaudid and anesthetic into the epidural space.  worked very well.

I would go with epidural again given the choice.

djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline Chondrosoldier

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Re: What are the others? further description of the epidural experience
« Reply #5 on: April 01, 2008, 02:36:10 AM »

Know David had an incredible experience with the epidural.  My case (multiple trochlear and a huge patellar lesion) is very comparable.  Having never had to see or deal with childbirth, thank God, I forgot to ask about the after-affects of the epidural?  Living by myself, want to be able to have the good leg immediately mobile post-operatively.  The pain-pump is an option which could help with the nerve block crash and the morphine drip machine is a must have.  What are the "other" pain control methods aside from epidural and nerve blocks?

Thanks again for your input.

Brant
« Last Edit: April 01, 2008, 05:23:16 PM by Chondrosoldier »
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant
Happiness!

Offline Army John

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #6 on: April 01, 2008, 02:50:00 AM »
I had a nerve block for my last surgery.  I was so looped that I never felt a needle go in my back so I guess that shouldn't be too big of a factor.  They don't last THAT long, so you'd need to supplement with oral or IV pain meds afterwards.  I don't know what the side effects would be.  My wife seemed fine after she gave birth and she ended up needing a c-section.

I go in for surgery this Thursday for an ACI/TTO and I intend on doing the epidural.  I don't care for being completely put under but I have less of a desire to feel my leg after surgery.  In fact, I just read an article that talked about the long term advantages of recovery if they can keep you pain free the first 72 hours.  Studies have shown your post op pain from that point on is far less and your need for pain meds is far less. 
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline David3

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #7 on: April 01, 2008, 03:26:44 AM »
Army John, I agree with your comment about minimising pain for the first 72 hours. Once I came off epidural (at about 48 hrs I seem to remember), my OS came by my hospital bed and upped the dosage of oral pain medication that the hospital had advised. He emphasised that if you get the pain under control early, then it will stay under control. Worked for me.
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline Army John

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #8 on: April 02, 2008, 01:33:46 AM »
David-

  I agree 100% with the initial pain management.  I go in for my ACI/TTO in less than 48 hours and I fully intend on having an epidural.  I don't want to feel anything.  When I had my ACL reconstructed years ago, I woke up and lived in hell for several days.  They never did a good job getting my pain under control- they gave me a shot of morphine in the recovery room and really nothing harder than percocet after that.  I also had a femoral block, which did absolutely nothing.  Either they missed, or I am immune to it. 

  When I had a nerve block for my knee scope a few months ago, I had had completely worn off by the time I was alert in the recovery room.  So I guess it lasted about 3 hours total.  I suppose the amount of medication affects all of it as I had a shoulder block in the past (I am an equal opportunity joint injur'er).  That block lasted over 24 hours.  I simply remember not suffering after an extensive shoulder reconstruction.

  In the end, I guess the magic bullet is the one that allows you to keep pain under control.  I just have to believe that an epidural is more capable of relieving pain than a nerve block over a sustained period.  As I said in an earlier post, they have had me so looped for every block I have ever had that I didn't care a needle was about to go deep into my body, and I certainly never felt it. 

   
« Last Edit: April 03, 2008, 02:14:53 AM by Army John »
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline MegTX

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #9 on: April 02, 2008, 01:52:16 AM »
I agree that whatever method is used, you have to get ahead of the pain and STAY ahead of it.  Once I was hurting baaad when the nerve block wore off on day 2, it seemed like nothing would make it stop.  If I'd have thought the ER would give me anything stronger than the Vicodin I already had, I'd have endured being put in the car and driven there.
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

dileigh

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #10 on: April 03, 2008, 12:56:10 AM »
I had an OnQ system and loved it.  I think it's a femoral block.  The med bypasses your digestive system completely which is really good for me.  It wasn't enough to be the only pain relief, but it did help during those first days.

a PCA pump is good because you don't have to wait for someone to give you anything, and has a safety to where you can't get too much.  I just have problems with the kind of stuff that goes in it.

The only epidural I can remember is after having a baby, and can't believe that it would last too long or you wouldn't be able to move at all.  You're pretty much numb from the torso down. 

Diana

Offline Chondrosoldier

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Re: Thanks Guys! Going with the Epidural
« Reply #11 on: April 07, 2008, 08:43:53 AM »
I like to tell my girlfriend that now I'll have a half-ass idea of what its like to go through pregnancy, even though I know it couldn't be further from the truth. :)

Not worried about the stick even though I requested a Valium for the benefit of the anesthesiologist.  Will document the hell out of rehab in later posts.  Had a similar experience to David3 on the other knee and am convinced my PT's individualized protocol is unbeatable.

Thanks again, Brant (chondrosoldier)
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant
Happiness!

Offline UNItwirler

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #12 on: April 07, 2008, 03:57:26 PM »
I did not have a nerve block or an epidural... no hospital stay either. I was in excruciating pain during the 3 hour car ride home from surgery, I could feel exactly where my tibia had been broken, it was sickening. Once I was home I was in a Game Ready Ice Machine practically non stop! The Ice really helped dull the pain!
-Lateral Release (R Knee) 1998
-Lateral Release (L Knee) 2004
-Biopsy for ACI (L Knee) 2005
-Microfracture (L Knee) 10/2006
-ACI/Distal Realignment[AMZ] (L Knee) 11/14/2007
-Screw Removal 7/08
-Scope 9/08

Offline Army John

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Re: Thanks Guys! Going with the Epidural
« Reply #13 on: April 07, 2008, 04:07:24 PM »
Not worried about the stick even though I requested a Valium for the benefit of the anesthesiologist.

Thanks again, Brant (chondrosoldier)

Oh, they'll use something much stronger than valium.  I just had my surgery last Thursday and once again, I don't remember feeling a thing.  My epidural stayed in about 48 hours.  They didn't max out on the epidural medication as I had control of my legs.  However, it kept the pain at bay. 
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline Julie P

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #14 on: July 22, 2008, 01:47:10 AM »
I would DEFINITELY say OTHER!  I perform the anesthesia for all of these procedures and am having an ACI/AMZ/Distalization in a few months.  I will list the pros and cons of all types.


There is a pain theory called gate control- the summary is that if you block your brain from "feeling" the pain in the first place you get a preemptive type of analgesia and hundreds of studies have shown that you have better pain control.  This can be done in a multitude of ways.  Listed below are some of the choices.


PCA- IV doses of narcotics- you push a button and you get the drugs.   Usually started AFTER you already start to feel the pain.  So it isn't prevented and does not follow the gate theory.  Patients that I have are usually not very satisfied with this pain control method for orthopaedic procedures.  Usually more helpful for soft tissue: abdominal procedures.  The benefits for ortho procedures are- not many other than you have control.
Cons- The more you use the button the more side effects you are likely to have- nausea, vomiting, constipation, sedation, and not a very dense pain control.  Can't go home with it.

Epidural- Definitely a pro.  If you are thin and have never had back surgery usually very easy to put in and have fabulous results while you are in the hospital.  Of course there are circumstances when it doesn't work but we can usually put it at a different level with success.  Some of the risks that go with it are headaches(most common in younger population), infection, not working, seizures, and bleeding.  You can have control of how numb you are (push the button) and usually do not need general anesthesia for the surgery itself.  The most major deterrent is that it can only be used while you are an inpatient and can not be used

Nerve Block- A pro for procedures that do not involve as much, such as a microfracture, scope, or lateral release.  Same risks as above except no risk of headache.  It usually only lasts 6 hours or so but can last as long as 18 hours depending on what type of local anesthetic and adjucts are used.  Still may need general anesthesia because the femoral block does not cover the discomfort from the tourniquet.  After about 1- 1 1/2 hours the tourniquet starts to get pretty uncomfortable.

Nerve Catheter- Pros-  I believe this is definitely the way to go.  Same risks as above.  However, the biggest pro and why I am going to have this is you can go home with the nerve catheter (continuous pain control)!!!!! for a few days, and they teach you how to dose yourself.  You have the benefits of being an inpt while laying in your own bed at home.  Cons- It can get dislodged and not work.

Hope this helps some of you to decide what type of pain control to have.

Julie
L hardware removal and scar revision 6/4/9
Left AMZ and medial release 1/8/09
ACI biopsy 11/4/08 and bilateral scopes
12-22-06  L -Microfracture lateral trochlea, LR, and removal of loose bodies
1999-Right knee Loose body removal chondromalacia