Re: Re: More info on Right TKR performed 10/8/08

[Guest guest]

With either a spinal or epidural, you can request the level of

consciousness you want -- I told my OS that I wanted to have no

knowledge of the surgery -- and I didn't. They time it perfectly as I

came to -- completely aware -- just as they were ready to roll me out

to the recovery room.

There are no studies I have read indicating that pain is less with an

epidural. Many surgeons leave some local anesthetic agent in the joint

which eases pain for about 24 hours afterward. Maybe by " pain " he

meant general difficulty in recovery -- i.e. one has had a tube down

one's throat and also is more likely to be nauseated and suffer side

effects from general.

I was told that the difference between an epidural and a spinal was

that a spinal will only last for a finite period of time whereas an

epidural lasts so long as they keep dripping it in -- this is why

epidurals are used for childbirth which can last an unpredictable

amount of time -- whereas an OS knows how long the surgery will take.

Most doctors recommend NOT having general if it can be avoided. It is

medically more dangerous and the recovery period can be more

difficult. Also general can increase the need for a transfusion since

it seems to affect clotting.

On Dec 6, 2008, at 4:44 PM, Goodman wrote:

> Sorry, I also forgot to mention - I had a spinal, not an epidural.

> Dr. Coon

> doesn't offer general anesthesia. They gave me Versed, then put in the

> spinal and the urinary catheter while I was completely unaware, then

> they

> let it wear off and said I could get more if I wanted it.

>

> With a spinal you are completely paralyzed from wherever, down,

> unlike an

> epidural. I don't know if docs use epidurals for knee replacement. -

> you

> would be able to move your leg.

>

> I was awake and talking during the procedure, and felt/heard the

> sawing and

> hammering vibration. I could have asked for more Versed so that I

> would be

> " out " , but didn't want it. It can be a weird sensation to be

> paralyzed but

> I had already had one spinal from a c-section so knew what to expect.

>

> There are some new studies that show that general anesthesia

> increases pain

> after surgery but that's sort of hard to prove.

>

> claire

>

> Callahan Goodman

>

> I was wondering about the epidural. Were you awake for the surgery?

> When I had my right knee done on Oct. 15th I was given the choice of

> an epidural or a general. I chose the general. I just wanted to be

> put out. I didn't want to hear what was going on. I am having my left

> one done this Wednesday and asked my doctor which is best and he said

> to chose the epidural as the pain is less after. He said I can also

> be put under so I don't hear anything.

>

> Can anyone tell me about the epidural, is it true that the pain is

> less and are you awake?

>

> Joanie

>

>

[Guest guest]

I had the Versed in my IV then what is called an intrathecal injection. It

goes in the spine (perhaps like the spinal you had) but is a single

injection that lasts a specific period of time. I remember being positioned

for the injection, then nothing until I was sitting up in recovery. I'm

grateful not to have heard any of the sounds of surgery. Also, my

understanding is that they packed the surgical site with morphine that wears

off in 24 hours or so.

Re: Re: More info on Right TKR

performed 10/8/08

With either a spinal or epidural, you can request the level of

consciousness you want -- I told my OS that I wanted to have no

knowledge of the surgery -- and I didn't. They time it perfectly as I

came to -- completely aware -- just as they were ready to roll me out

to the recovery room.

There are no studies I have read indicating that pain is less with an

epidural. Many surgeons leave some local anesthetic agent in the joint

which eases pain for about 24 hours afterward. Maybe by " pain " he

meant general difficulty in recovery -- i.e. one has had a tube down

one's throat and also is more likely to be nauseated and suffer side

effects from general.

I was told that the difference between an epidural and a spinal was

that a spinal will only last for a finite period of time whereas an

epidural lasts so long as they keep dripping it in -- this is why

epidurals are used for childbirth which can last an unpredictable

amount of time -- whereas an OS knows how long the surgery will take.

Most doctors recommend NOT having general if it can be avoided. It is

medically more dangerous and the recovery period can be more

difficult. Also general can increase the need for a transfusion since

it seems to affect clotting.

On Dec 6, 2008, at 4:44 PM, Goodman wrote:

> Sorry, I also forgot to mention - I had a spinal, not an epidural.

> Dr. Coon

> doesn't offer general anesthesia. They gave me Versed, then put in the

> spinal and the urinary catheter while I was completely unaware, then

> they

> let it wear off and said I could get more if I wanted it.

>

> With a spinal you are completely paralyzed from wherever, down,

> unlike an

> epidural. I don't know if docs use epidurals for knee replacement. -

> you

> would be able to move your leg.

>

> I was awake and talking during the procedure, and felt/heard the

> sawing and

> hammering vibration. I could have asked for more Versed so that I

> would be

> " out " , but didn't want it. It can be a weird sensation to be

> paralyzed but

> I had already had one spinal from a c-section so knew what to expect.

>

> There are some new studies that show that general anesthesia

> increases pain

> after surgery but that's sort of hard to prove.

>

> claire

>

> Callahan Goodman

>

> I was wondering about the epidural. Were you awake for the surgery?

> When I had my right knee done on Oct. 15th I was given the choice of

> an epidural or a general. I chose the general. I just wanted to be

> put out. I didn't want to hear what was going on. I am having my left

> one done this Wednesday and asked my doctor which is best and he said

> to chose the epidural as the pain is less after. He said I can also

> be put under so I don't hear anything.

>

> Can anyone tell me about the epidural, is it true that the pain is

> less and are you awake?

>

> Joanie

>

>

[Guest guest]

oh i was thinking if i could get the money but then don't know about flying back

to Oklahoma after surgery.

Sharon LeVine

Re: More info on Right TKR performed

10/8/08

Sorry, I should have mentioned, I live about 2.5 hours from Red Bluff, CA.

About half of Dr. Coon's patients are not local.

Callahan Goodman

so you went to CA to get your knee done?

Sharon LeVine

[Guest guest]

I haven't had mine yet. Scheduled for Dec 16th. But my surgeon uses the

epidural too, but it is used for after surgery. They use a spinal block of

some kind for during surgery so you feel nothing from the waist down. I was

concerned because I don't like the idea of having that needle stuck in my

spine. Anyway, the explanation is that you aren't " under " as far this way,

so you can wake up quickly and they don't have to use the tube down your

throat for respiration. I believe they use Versed so that you are not aware

of anything going on. I didn't want to be awake either. Doc says I would not

be awake, but just under enough to be " out " and the spinal that paralyses

you from the waist down would take care of all the pain during surgery. As

soon as they stop that medication (spinal), then they use the epidural for

the after pain. And you don't get any of those spinal/epidural shots until

you are out. That's how it was explained, anyway.

Chrissie

To those who believe, no explanation is necessary; to those who dont, no

explanation is possible

Re: More info on Right TKR performed

10/8/08

I was wondering about the epidural. Were you awake for the surgery?

When I had my right knee done on Oct. 15th I was given the choice of

an epidural or a general. I chose the general. I just wanted to be

put out. I didn't want to hear what was going on. I am having my left

one done this Wednesday and asked my doctor which is best and he said

to chose the epidural as the pain is less after. He said I can also

be put under so I don't hear anything.

Can anyone tell me about the epidural, is it true that the pain is

less and are you awake?

Joanie

>

> Great post , I always wondered why there was no pain at

first,

> I thought it was the epidural.

>

> I just had my 6 week check up (at 7 weeks) in Dr. Coon's new Napa

> Valley office. It's nice, and so much closer and more fun.

>

> Hollie

>

> > I had requested a complete copy of my chart from my TKR doc (Dr.

>

> > Coon, Orthopedic Surgical Institute, Red Bluff, CA) since he is

> pretty far

> > away, and I wanted to know which implant was used, and needed

> copies for my

> > bone specialist and rheumatologist.

> >

> > I just got the package, and it cost $15.37 for copying!

> >

> > Anyway, drum roll, I got the Stryker Triathlon in my right knee.

> The

> > description of the procedure is worth the 15 bucks - it's

> interesting that

> > they refer to two " stab wounds " made " three fingerbreadths

> proximal to the

> > lateral rise of the femur " and " anteriolateral 3 cm distal to the

> tibial

> > tuberosity " . " Stab wounds " .

> >

> > I was 53 years old, so younger than " average " for this procedure -

> but I

> > have 5 autoimmune diseases and this has been blamed for why my

> knees wore

> > out early. I blame the stairmaster, myself. In any case, the

> surgeon notes

> > that " examination showed severe patellofemoral arthritis with

> eburnation of

> > the patellar and trochlear bone. Synovial biopsies were taken.

> It was

> > noted that the bone on all aspects of the joint was a dark brown

> in color

> > which is quite unusual. This was felt to be due to hemosiderin

or

> heavy

> > metal disposition, possibly metabolic bone disease such as

> Gaucher's

> > disease. Bone fragments were sent to pathology for analysis. "

> >

> > Although Dr. Coon was shocked at the color of the inside of my

> bones, the

> > pathology report on the slice that he sent came back " normal " .

> Hmmmm! He

> > said he had never seen bone that color before, and this is a guy

> who does

> > 600 knees a year.

> >

> > Later in the report it states that a " size 3 MIS min keel tibial

> component

> > was placed " - this is the trial component which is tested bending

> the leg

> > every which way, then removed. I then received the Stryker

> Triathlon,

> > apparently size 1.

> >

> > 2 grams of Vancomycin was mixed with the cement before it was

> applied. The

> > posterior capsule was injected with a combination of ropivacaine,

> > epinephrine, Toradol, morphone and Clinidine. This all resulted

> in the knee

> > not hurting much for the first 2 days, then hurting a LOT!

> >

> > The case classification was " clean " .

> >

> > The blood loss was estimated at 10 mL.

> >

> > I had pain management issues going into this surgery, and they

got

> flared up

> > by the stress of the surgery. Therefore I was hospitalized 3

more

> times

> > after the surgery - not for the knee, really, but for overall

high

> pain

> > levels. I have finally gotten stabilize and am feeling pretty

> good, though

> > my knee hurts when I overdo it. My orthopedist warned that even

> though I

> > have been walking on it from day one, can run up and down stairs,

> and have

> > great flexion (130 or so), the real recovery of the body from

this

> surgery

> > takes about 4 months, and I am only half that far now.

> >

> > I just thought I would share this since it could be of interest

to

> others

> > who have had or are going to have this surgery -

called " minimally

> invasive

> > TKR " .

> >

> > The bad news is that my other knee is really bad too, and it

looks

> like I

> > will have to go through this again in a year. Sigh.

> >

> > claire

> >

> > Callahan Goodman

> >

> >

> >

> >

> >

[Guest guest]

I had a general with my thr in February and I had nerve blocks for my btnr in

June.  My nerve block wasn't in the spine but went down the inside of both of my

thighs.  They couldn't use my spine because I'm on blood thinners.  The benefit

of the nerve block is that it administered the drug into the legs the few days

after surgery.  They removed the small cathetors that went down my leg when I

was released to go to rehab.  I had the morphine pump too and needed it all. 

With the nerve block, I was not awake for the surgery.  I could feel my legs

after the surgery to a small extent..

 

________________________________

From: shihtzumom <shihtzumom1@...>

Joint Replacement

Sent: Sunday, December 7, 2008 1:03:48 PM

Subject: RE: Re: More info on Right TKR performed

10/8/08

I haven't had mine yet. Scheduled for Dec 16th. But my surgeon uses the

epidural too, but it is used for after surgery. They use a spinal block of

some kind for during surgery so you feel nothing from the waist down. I was

concerned because I don't like the idea of having that needle stuck in my

spine. Anyway, the explanation is that you aren't " under " as far this way,

so you can wake up quickly and they don't have to use the tube down your

throat for respiration. I believe they use Versed so that you are not aware

of anything going on. I didn't want to be awake either. Doc says I would not

be awake, but just under enough to be " out " and the spinal that paralyses

you from the waist down would take care of all the pain during surgery. As

soon as they stop that medication (spinal), then they use the epidural for

the after pain. And you don't get any of those spinal/epidural shots until

you are out. That's how it was explained, anyway.

Chrissie

To those who believe, no explanation is necessary; to those who dont, no

explanation is possible

[Total_Joint_ Replacement] Re: More info on Right TKR performed

10/8/08

I was wondering about the epidural. Were you awake for the surgery?

When I had my right knee done on Oct. 15th I was given the choice of

an epidural or a general. I chose the general. I just wanted to be

put out. I didn't want to hear what was going on. I am having my left

one done this Wednesday and asked my doctor which is best and he said

to chose the epidural as the pain is less after. He said I can also

be put under so I don't hear anything.

Can anyone tell me about the epidural, is it true that the pain is

less and are you awake?

Joanie

>

> Great post , I always wondered why there was no pain at

first,

> I thought it was the epidural.

>

> I just had my 6 week check up (at 7 weeks) in Dr. Coon's new Napa

> Valley office. It's nice, and so much closer and more fun.

>

> Hollie

>

> > I had requested a complete copy of my chart from my TKR doc (Dr.

>

> > Coon, Orthopedic Surgical Institute, Red Bluff, CA) since he is

> pretty far

> > away, and I wanted to know which implant was used, and needed

> copies for my

> > bone specialist and rheumatologist.

> >

> > I just got the package, and it cost $15.37 for copying!

> >

> > Anyway, drum roll, I got the Stryker Triathlon in my right knee.

> The

> > description of the procedure is worth the 15 bucks - it's

> interesting that

> > they refer to two " stab wounds " made " three fingerbreadths

> proximal to the

> > lateral rise of the femur " and " anteriolateral 3 cm distal to the

> tibial

> > tuberosity " . " Stab wounds " .

> >

> > I was 53 years old, so younger than " average " for this procedure -

> but I

> > have 5 autoimmune diseases and this has been blamed for why my

> knees wore

> > out early. I blame the stairmaster, myself. In any case, the

> surgeon notes

> > that " examination showed severe patellofemoral arthritis with

> eburnation of

> > the patellar and trochlear bone. Synovial biopsies were taken.

> It was

> > noted that the bone on all aspects of the joint was a dark brown

> in color

> > which is quite unusual. This was felt to be due to hemosiderin

or

> heavy

> > metal disposition, possibly metabolic bone disease such as

> Gaucher's

> > disease. Bone fragments were sent to pathology for analysis. "

> >

> > Although Dr. Coon was shocked at the color of the inside of my

> bones, the

> > pathology report on the slice that he sent came back " normal " .

> Hmmmm! He

> > said he had never seen bone that color before, and this is a guy

> who does

> > 600 knees a year.

> >

> > Later in the report it states that a " size 3 MIS min keel tibial

> component

> > was placed " - this is the trial component which is tested bending

> the leg

> > every which way, then removed. I then received the Stryker

> Triathlon,

> > apparently size 1.

> >

> > 2 grams of Vancomycin was mixed with the cement before it was

> applied. The

> > posterior capsule was injected with a combination of ropivacaine,

> > epinephrine, Toradol, morphone and Clinidine. This all resulted

> in the knee

> > not hurting much for the first 2 days, then hurting a LOT!

> >

> > The case classification was " clean " .

> >

> > The blood loss was estimated at 10 mL.

> >

> > I had pain management issues going into this surgery, and they

got

> flared up

> > by the stress of the surgery. Therefore I was hospitalized 3

more

> times

> > after the surgery - not for the knee, really, but for overall

high

> pain

> > levels. I have finally gotten stabilize and am feeling pretty

> good, though

> > my knee hurts when I overdo it. My orthopedist warned that even

> though I

> > have been walking on it from day one, can run up and down stairs,

> and have

> > great flexion (130 or so), the real recovery of the body from

this

> surgery

> > takes about 4 months, and I am only half that far now.

> >

> > I just thought I would share this since it could be of interest

to

> others

> > who have had or are going to have this surgery -

called " minimally

> invasive

> > TKR " .

> >

> > The bad news is that my other knee is really bad too, and it

looks

> like I

> > will have to go through this again in a year. Sigh.

> >

> > claire

> >

> > Callahan Goodman

> >

> >

> >

> >

> >