Pain management options following knee replacement surgery? - Pain Management Message Board

ahabt · 10-10-2009, 10:55 AM

I had a total hip replacement in February that went well except for pain management afterward. I apparently can't take any opiate-family medications, at least not orally. I have a along history of convulsive vomiting that goes on for hours if I take codeine, vicadin, any of the meds in that family. Immediately following the hip surgery I was on a pain pump with an alternative to morphine for about 24 hours, and that worked well. Then they took me off that and started giving me oral percocet, which I had never had before so they thought might be OK, but I had a miserable day or so of vomiting and, of course, no pain control either. Then they gave me medication to control the vomiting, which did only that, did not control the feeling of nausea. Finally after the third day I stopped taking both meds because the continual nausea was worse than the pain, and didn't take anything but aspirin after that.

I'm now due for a total knee replacement, and have been putting it off because I'm apprehensive about pain control. I have heard that pain is more of an issue with a knee replacement than with a hip. My sister, who is an RN, says that probably what I need is demerol, but it's such a frequently abused drug that they don't like to prescribe it for anybody who knows enough to ask for it. Is there anybody who has been through this kind of situation, and has advice to offer?

(I'm 62, reasonably healthy except for the severe osteoarthritis that is leading to all this surgery.)

Boxerluver · 10-10-2009, 02:04 PM

Hi, many people have that reaction to narcotics, my husband is one of them. Although we have figured out if he just has one is is usually OK. He is having some dental work done soon and I am worried that he will not have pain control.

As far as asking for demerol, since you have had previous surgeries and had problems with vomiting on them, I can't see why it would be a problem to ask for something that will not make you vomit. If you could get your hospital records from that other surgery and find out what they gave you in the pump, and that it didn't make you sick, they should just give you the same med. Fentenyl is another option, I've heard it is a close derivative of demerol so it may work for you as well. There is nothing wrong with asking for a med that worked when others make you that sick. Your records should also show you were throwing up with the meds so that may help you also.

Good luck!
Melissa

Executor · 10-11-2009, 08:57 AM

Quote:

Originally Posted by ahabt

My sister, who is an RN, says that probably what I need is demerol, but it's such a frequently abused drug that they don't like to prescribe it for anybody who knows enough to ask for it. Is there anybody who has been through this kind of situation, and has advice to offer?

Your sister is right...To a certain point. Yes, if someone comes into the ER and says "Hey, I hurt my back and only Demerol works", then yes, that's a red flag. But in your case, not even close. With all due respect, she's comparing apples to oranges.

If it were me, I would make an appointment with the surgeon and tell them about what happened with the prior surgery. Tell him everything in detail and about how you're scared to death. Any good surgeon would be compassionate because having surgery without pain control is like torture.

If the morphine drip in the hospital worked, I wonder if they could try oral morphine pills...MsContin, Kadian, or Avinza? Or the Demerol as your sister suggested? Given what happened to you, there is absolutely nothing to worry about re: mentioning these meds by name. I would tell the Doc straight up that you are concerned and you went to the internet for help, talked to your sister, and others.....And this is what you've come up with. You're asking for adequate pain control following surgery, not for long term maintenance. Two different animals altogether.

Quite frankly, it's up the surgeon, and the anthesiologist to figure this out. No one can be expected to go through knee replacement without adequate pain control. From what I know about it, you'll need reasonable pain relief for several weeks following the procedure. Sounds like anything dosed with Oxycodone, hydrocodone, or codeine is out of the picture. That leaves oral morphine, demerol, or fentanyl. I would ask about the fent patch, altough it's not recommended for acute pain. But in your case, your options are severely limited. This is where the expertise of your Docs come in. You may need a special consult with the anthesiologist. I would....Because he will be the one controlling your pain immediately after the surgery, and then your Doc takes over from there.

Best of luck with this.

Regards,

Ex