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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 9502 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

Offline MegTX

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #15 on: July 22, 2008, 02:15:52 AM »
Julie, thanks for the info... when you say "nerve catheter"... is that something like the On-Q system?  There is a decent chance I'm going to have to have ACI/TTT or TTT/Microfracture on my other leg in a year or two, once we get this leg completely stable, and I never want to go through the HELL I did with days 2 and 3 post-op.  My OS only does outpatient, so I'm limited to a degree in what I can request, but I have GOT to have another option besides OD'ing on hydrocodone if I dance this dance again.  I'm trying to get as educated as possible about all the pain management techniques so I can argue them with my OS.  He's highly competent with the surgical techniques, I'm just getting the impression he's a bit cavalier about pain control post-op.  He thought that the nerve block and washing the surgical sites with an opiate would give me a few days relatively pain-free and wear off gradually.  He was dead wrong.  They had to give me more morphine post-op than I've ever had on board before, just to get me to the point I could stand to be moved and put in a wheelchair to go out to the car.  My pain was never completely under control until at least day 4 post-op.  To me, that's just completely unacceptable.
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 KW

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #16 on: July 22, 2008, 02:24:20 AM »
Meg,  I have had 1 TTT w/out and 2 with the On-Q and I will never have another major knee surgery without it again.  For me the system did a great job controling my pain through the 1st 3 to 4 days when it is the worst.

Karen
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline Julie P

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #17 on: July 23, 2008, 09:02:45 PM »
Meg,

The OnQ system is a "brand name".  The hospitals that I work at we use the ON-Q systems on open heart patients and some big thoracic and abdominal procedures.  We use different pumps that can be manipulated more for the orthopaedic procedures.  The surgeon places them intraop for the general and CV/Thoracic cases in the subcutaneous tissue and it only gives local coverage.  It does not cover the whole area. 
Now for the orthopaedic procedures, the anesthesia staff place the catheters and confirm it is by the nerve before stitching it in place. We use a different kind of pump that can be more set and individualized than the ONQ.  This is done in the preop holding area before the surgeons even make incision....thus "blocking" the brain from even getting the pain signal and if your leg reads the studies they will know that they should have a lot less pain long term cause your brain never recevied a lot of the pain signals. :) :D  Sounds weird, but the research supports it.

Now with that being said, obviously reading others posts that some institutions may be using them as a slow delivery device for nerve infusions.  If that is the case, it IS being used as a nerve catheter.  The limitations will be depending on who places it (surgeon vs anesthesia) and if they place it near the nerve or in the joint space.  Near the nerve will give you much much better pain control.   The infusion goes at a certain baseline that is set and you can give yourself a bolus dose of up to 5mL. 

Not sure why your surgeon did not admit you overnight for pain control.  One of the indications for admission is intractable pain.  Even if your insurance initially did not approve overnight, this is one reason that is then allowed.  As far as planning for next time, ask for a continuous femoral nerve catheter infusion if you have to go home that day.  If you get to stay for a few days, you can also consider an epidural.

Hope that helps.  I will keep an eye on this post if you have any other questions.  I too will be having ACI to trochlea and patella along with Fulkerson in January.  So I like reading other people experiences with their rehab.

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

Offline MegTX

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #18 on: July 24, 2008, 04:03:42 AM »
Julie, thanks again for the info.  I'll definitely be better armed if I have to go through this again.

My OS doesn't do this operation in a hospital, he has a surgical center with his orthopedic practice partners and there are no overnight facilities or provisions.  So overnight and all the pain control mechanisms that go along with that aren't an option.  I'm not sure what he does with other patients that are going to have to have overnight, like hip replacements & such.  I know he has privileges at the local hospital, but it was never even discussed as an option for me.

I completely understand what you're saying about it being best if the pain signal doesn't even get to the brain.  It makes perfect sense.  (I have a bit of a medical background, so I get the anatomy & physiology... it also makes me a bitch of a patient ::wink:: )  I know that when I'm managing pain, I cannot let the pain "get ahead of me" or it's like fighting up a waterfall to get it back under control, and the longer I hurt it seems like the lower my pain threshhold gets.

I'd dearly love for our surgeons to have had to have the surgery they're doing on us, or something similar.  I don't think they really "get it" until they've experienced it themselves.  We have to so often educate ourselves and push for the things that we know aren't negotiable.
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 courtem10

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #19 on: February 10, 2009, 03:15:21 PM »
Julie,

I was reading your info on the nerve catheter- i will be having patella ACI/HTO this spring and need to prepare for pain. when do they finally take the catheter out and what is the pain like as they are removing the device?? i don't think i can deal with the epidural- i have serious needle phobia
7/08 Left knee microfracture
12/08 Left knee ACI biopsy
4/09 Left knee ACI/AMZ

dileigh

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #20 on: February 10, 2009, 11:07:01 PM »
I took the catheter out at home and it didn't hurt except for where the tape grabbed some hairs  ;D


Diana

Offline Julie P

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #21 on: February 10, 2009, 11:49:38 PM »
Removing the catheters are not a big deal at all.  It is similar to taking out an IV, except the tubing is even smaller in diameter.  You shouldn't feel anything at all, except for the tape coming off your skin.  As far as epidural, it is a good option and shouldn't be concerned about needle phobias for it.  When placing the epidural you should be very sedated and possibly may not even remember them placing it.  Also local anesthetic is used on the area prior to placing the epidural catheter so it really doesn't hurt.  I wouldn't even let that be a determining factor in the decision making process. 

HTOs are pretty painful, if it was me, I would seriously consider the epidural if you are staying overnight for awhile.  If you are going home then do the nerve catheter. 

Hope that helps.
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

Offline courtem10

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #22 on: February 11, 2009, 05:02:41 PM »
i am planning on spending 1 night in the hospital following ACI/HTO so i guess the epidural would be the better option. i just need to discuss this first with my os. pain management is a top concern for me heading into this procedure
7/08 Left knee microfracture
12/08 Left knee ACI biopsy
4/09 Left knee ACI/AMZ

Offline Julie P

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #23 on: February 11, 2009, 07:42:25 PM »
If you are only staying 1 night an epidural may not be the best choice then.  Epidurals are better is you are staying for 2 or more days.  The reason being, you will need time once they take it out to start walking on your crutches and prove that you can pee.  You can't do that when you are numb from the epidural.  A nerve catheter or block would be a better option due to your short stay.  Also many OS have a certain way they want it done so they may not really give you a choice, unless he/she has already told you it is your choice.  Regardless pain management is also a top concern to them so they will make sure you are comfy.  Good Luck. 
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

Offline SarahMN

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #24 on: February 11, 2009, 10:18:41 PM »
I like epidurals.  But I have not had the Q--.  You feel nothing until it wears off.  Usually you have a cath for urinating, which would have been great for my and my dh after my last surgery.  I had to get up and potty all night long.  I ended up using a male/female bottle thing that I had at home, sitting on the end of the couch.  I couldn't get up on my knee any more, and it was 5:30 a.m.  My dh and I had been up all night. 

They gave me some form of cortisteroids during the surgery, plus the lidocaine type drug to numb my knee area.  The steroids cause the frequent urination, and any of the marcaine/novacaine stuff makes me wakeful.

So I would opt for an epidural, with my prior experiences.  My epidurals were in my back, and I couldn't see it going in.  Felt nothing.

I did have a nerve block for my shoulder surgery, and it did wear off.  The oral meds made me vomit.  So pain plus vomiting was a drag.

Some sort of pump to a nerve sounds great, if it works as advertised for several days, or would work in me.  I know that an experienced anesthesiologist is key in placing any sort of nerve block, epidural or otherwise.  I did have a tube left in my shoulder, catheter type that I could press to shoot in marcaine.  Darn near useless as far as I could tell.

I agree that the pain gate is something you don't want to cross post op.  Once the pain starts it is hard to shut down.  I usually end up vomiting from most narcotics, IV or pills.  But once the pain starts, from what a few MD/OSs have said, in the knee, you are at risk of having the quads do some sort of protective shutdown. 

After my last knee surgery, which was done arthro, I had conscious sedation, and then marcaine shot into the knee.  It was not a good set up.  It was day surgery, I came home, the marcaine had already worn off in the RR and I was asking for IV pain meds.  Then I came home with oral narcotics, and the vomiting and potty problem while crying in pain was not ideal.  Nightmare.

Also, my quad muscles "shut down" due to the pain.  I don't understand it, so cannot explain it well.  But the self defense mechanism of the knee pain post op overload made them stop responding.  They did not show up until day 19.  So the quads just atrophy.  I was going to get some EMS to restart/train them, but they were back by then. 

I would hope that on my next surgery I could have an epidural, and avoid the first day/s of major pain.  Maybe my quads will keep working that way.  Also the epidurals I have had have worn off gradually, even after they take the cath/needle out.  I loved not having the pain, and would go with one again.  I will beg for it actually.  I don't like general anesthetics, due to my own reactions with lots of nausea, and a depression.

I hope I didn't confuse anyone.  I am only sharing my own preference.  I am sorry for anyone who experiences any major pain post op.

Good luck, Sarah MN

Give me an epidural any day.
3/25/09: R Knee: Arthofibrosis (LOA), chrondoplasty, excise plica, anterior interval release.
11/12/08:  L Knee: LR, Chrondoplasty of patella & MFC, Excise Plica, Synovectomy - 2005-2008: 12-16 weeks bi liateral knee injections with steroids. 
---& tried Synvisc, nothing but cost & 9-10 pain.

Offline courtem10

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #25 on: February 18, 2009, 05:47:35 PM »
i was reading somewhere that a patient had 2 different types of nerve blocks- one with the sciatic and i can't remember the 2nd. is there actually more than 1 type of nerve block? and is one stronger than the other?
7/08 Left knee microfracture
12/08 Left knee ACI biopsy
4/09 Left knee ACI/AMZ

Offline Peg Leg

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Re: Best pain Control for ACI/TTT surgery: Epidural or Nerve Block+why?
« Reply #26 on: February 23, 2009, 02:37:12 AM »
Hi,

I had some major pain issues with my ACI surgery, so when I needed a Fulkerson AMZ 10 months later, we decided on a Femoral nerve block and a Sciatic nerve block.  It worked really well and I had very little pain; I also had a morphine pump (they weren't taking any chances!!).

Good luck!

Peg Leg
10/06  Miicrofracture Rt knee on mfc
defect was 1.3x2, small defect under patella
04/07 Arthroscopy/Cell harvest for Carticel
06/28/07 Carticel surgery ,Rt. Knee
12/27/07  Scope to debride Patella lesion,Rt. Knee
4/17/08  Fulkerson AMZ, Rt. Knee
6/25/09 ConforMis BiCompartmental Knee Replacement