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Author Topic: Pre-op concerns-questions re: nerve block? ACL graft from opposite knee?  (Read 5265 times)

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Offline kpoppy

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Hello-
I am "officially" new to this board a couple weeks ago.  I will in advance thank all of you that I have sponged valuable information and inspiration from over the last year of reading KG posts.  It has helped steer me in the right direction of getting my knee fixed.

I was hoping to hear about experiences with the following topics as my surgery is next week.  I will be undergoing my 3rd Right ACL reconstruction using a bone-patellar tendon-bone graft from my Left knee, as well as a PLC procedure with an allograft and peroneal nerve decompression.

Pros and cons about nerve blocks? Does it shut down the quadriceps? Anyone have the graft harvested from their opposite knee? If so, how did it affect your initial mobility?  Anyone with experience with a peroneal nerve decompression? Complications?      Much Thanks!  KP                                         
« Last Edit: July 16, 2010, 05:46:44 AM by kpoppy »
R ACL,MCL,med/lat men tears- basketball 06.

ACLr w/ BPTB auto, w/intraop. patellar fx/ORIF 06

Med/lat part. meniscectomies 07, Post-op infection, I & D.

Revision ACL w/ ham auto 1/09.

Bone graft ACL tunnels, debridement AF Jan. 2010

ACL Revision #2/PLC procedure July 21, 2010

Offline Kaputt_Knee

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  • [Ed: Sue sadly passed away in 2016]
No, the nerve blocks I've had did not shut down the quad, they just ensured that the bone pain around the knee was bearable without resorting to heavy duty pain control.

It varies from hospital to hospital and anaesthetist's technique as to what and how it is done. I had a catheter inserted into the groin (on the side of the leg to be operated on). This was then adjusted by getting an involuntary movement of the lower leg. They do this after they have knocked you out in the operating theatre (in the gas room here in Germany, where the "gasmen and women play with their toys before the fun starts for the surgeon in the OP proper!  ;D).

I've had femoral blocks that were removed after the operation was completed and I've had blocks that remain in for about a week with a pain control pump. Each time the quads were only marginally affected and they quickly recovered as soon as the block was removed.

Talk to the anaesthetist when you have your pre-op check if it is worrying you. If you are having any type of reconstructive work that involves a lot of bone drilling, scraping and stuff, grab that block with both hands and hang on tight. Without it it is initially your worst possible nightmare about having pain that you cannot "reach". Think tooth ache with an abscess thrown in for good luck, then multiply it by a million or two!


Good luck

Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline Snowy

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I had an ACL reconstruction on Friday (hamstring graft from the same leg) without a nerve block, as the anaesthetist I had doesn't use them. I would thoroughly endorse Sue's recommendation of getting one! Because almost all the post-op accounts I'd read were from people who had had nerve blocks, I was entirely unprepared for the level of pain without one. As a result I didn't get on my pain meds quickly enough when I was discharged from hospital, let the pain get ahead of me and had a really miserable first 24 hours. I thought I was just being a wimp till I went back and looked at other people's threads, and realized that all those folk who'd been saying "The post-op pain was very manageable and nowhere near as bad as I expected" had had the benefit of a nerve block!

Good luck with your operation. I can't imagine going through all of this three times! I do hope that this one works out for you.

Take care,

Kay
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline crankerchick

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    • Derotation osteotomy & TTT Post-op diary
I guess the matter of a nerve block depends on the person and the doctor. My doctor does not use nerve blocks as he wants his patients moving their operative limb after surgery. I know for his ACL patients they do not get nerve blocks and they begin range of motion movements soon upon waking from surgery.

For my surgery, I had plenty of bone work done and no nerve block either. Now, of course I didn't have tunnels drilled in my bone for an ACL reconstruction, but I like to think that having my femur and tibia both chopped in half and spun around and a chunk of my shin also cut away and screwed back in would hurt all the same as drilling tunnels, but what do I know.

I have seen some people report on here the feeling of not being able to use the bathroom as a con against the nerve block, along with the general feeling of unawareness of the limb and how much is "too much" since it is numb.

Just remember, pain is subjective. What is awful to one person is tolerable to the next.

For your question about the contralateral approach for the graft, I don't think there are many on here that have had it and are actively posting. I can refer you to some sites offline with accounts of people who have undergone the contralateral approach if you are interested. Regarding mobility, it really doesn't matter whether the graft comes from the same leg or the opposite leg, your level of mobility is a function of how much your doctor allows you to do and how much you are willing to do. I have seen with my own eyes people have the contralateral patella tendon reconstruction and literally walk out of the hospital the same day sans crutches, ride a stationary bike at 4 days post-op, and return to sports in 3 months time no problem.
« Last Edit: July 16, 2010, 06:26:54 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Snowy

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In fairness, I should add that the failure to stay ahead of the pain when I got home was my own fault - if you opt not to have the nerve block, just be sure to follow exactly whatever advice you're given about pain control. If I'd started my meds on schedule I likely wouldn't have had such a rough time of it.

Cranker does make a very good point about the benefits of being able to have immediate post-op feedback from the operated limb - that is something I appreciated. I just let the feedback get a bit too intense. ;)
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Kaputt_Knee

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  • [Ed: Sue sadly passed away in 2016]
A femoral block properly and skilfully used reduces the deep seated pain caused by drilling into the femur and tibia. It can help with the initial post-operative pain and allow the patient to become accustomed to the immediate post operative recovery routine.

I have never had problems with any upper leg or other bodily functions, nor have I witnessed any in the centres where I was operated on. As I have had other procedures done at the same time I was not allowed to do any weight bearing exercises within the first 24 hours. However, the first 24 hours after major trauma to the knee, be it surgical or accidental, it is better to allow the knee to settle down and get on with sorting itself out. I've been involved with "aggressive" rehab - back skiing after 5.5 months is not exactly a slacker's program. Even when on a pain control pump which was attached to the same femoral block catheter, for a week, I did not suffer any side-effects other than having a cold lump of putty from the knee downwards! According to my roomies, I was also exceedingly "happy" most of the time  ;D Mobilisation began within 24 hours with passive manual therapy (i.e a physio moved my leg/knee and massaged the whole area).

So-called aggressive rehab is not for everyone and sometimes effective pain control is as beneficial if not moreso in the long term.

As with the femoral block - horses for courses - what suit some does not always suit others. If really reading and researching this board teaches you anything at all, it is that there is no such thing as a "standard procedure and rehab".

 ;)

1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline crankerchick

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Sue is definitely right about the no "standard procedure and rehab." Different strokes for different folks, and that includes doctors.

Whether it is better to allow the knee to settle down in those first 24 hours or not even falls into that category of different strokes for different folks. One doctor might throw someone in an immobilizer for a week post-op and still another one might have his patients walking without crutches.

The most important thing in my opinion is to talk with the doctor about his/her post-op protocol and what you can expect with that doctor. Anesthesia should be one of the things on the list. Make sure you are comfortable with whatever methods your doctor advocates. Aggressive rehab or not, in general, a particular doctor's post-op protocol may not be the right protocol for that individual, that is why I say people should ask about it before surgery and make sure they are ok with their doctor's approach.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline mollyc

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Hi KP: Just wanted to say that I loved my nerve block. Made the first 24 hours very comfortable, which enabled me to get home and get settled. (In the US, they send you home after an hour or so in the recovery room.) I had no trouble moving around on crutches, getting up the stairs to my 2nd floor flat, using the bathroom, etc. (I was also in an immobilizer for 3 days, so not allowed to bear weight anyway.) As soon as I started to feel my leg again the next day, I started doing quad sets (per surgeon's orders) and never lost the ability to keep my quads firing. I would have no hesitation about getting one again. Molly
Ski accident 2/14/09
Ruptured ACL, MCL sprain, bone bruise
ACLr allograft 5/27/09
Knee now 100% fine...skiing and playing tennis regularly

Offline kpoppy

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Much thanks everyone.  Excellent advice on the nerve blocks. I'm assuming it's the femoral nerve block you are speaking of and not the sciatic.  Don't know if I have the option for both.  I will find out on my pre-op visit with the anesthesiologist on Tuesday.  I've done pretty good without them thus far, but if there are few downsides, I will consider as I will be having an open PLC procedure as well this time.

crankerchick- as far as mobility and the contralateral graft...  I didn't have much option as my surgeon prefers the bone patellar tendon bone graft, especially since this is a revision into newly bone grafted tunnels (taken from my iliac crest 6 months ago). My same side patellar tendon and hamstrings were already used in previous surgeries.  Anyway, I should be weight bearing as tolerated on the graft side, but unfortunately will be NWB on the reconstructed side due to the revision status and PLC procedure.  I've read elsewhere that aggresive activity on the contralateral graft side can cause some problems at the patella (ie fractures). So my only real concern was the fact that I will be hopping on that side for 4-6 weeks.  Also, I would imagine going through an osteotomy to be far worse pain than 2 or so small drill holes...

Snowy- keep up the hard work...

Thanks! and take care all, KP
R ACL,MCL,med/lat men tears- basketball 06.

ACLr w/ BPTB auto, w/intraop. patellar fx/ORIF 06

Med/lat part. meniscectomies 07, Post-op infection, I & D.

Revision ACL w/ ham auto 1/09.

Bone graft ACL tunnels, debridement AF Jan. 2010

ACL Revision #2/PLC procedure July 21, 2010

Offline mollyc

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Yes, femoral nerve block for me.
Ski accident 2/14/09
Ruptured ACL, MCL sprain, bone bruise
ACLr allograft 5/27/09
Knee now 100% fine...skiing and playing tennis regularly