OSA AND TOTAL KNEE REPLACEMENT SURGERY

[codinqueen]

I am scheduled to have a total knee replacement April 24th, maybe sooner if they get a cancellation from someone else on the roster. I am worried that they will not fully relieve my immediate post-op pain by using a patient-controlled analgesia IV or strong enough pain medicine because of my OSA. I plan on being well enough to be back at work by 4 weeks, so I need to have pain controlled well enough to do the PT exercises. I also know I must take my CPAP friend with me for my hospital stay, and plan to do so.

Has anyone here who has OSA had this surgery recently and can anyone tell me about post-op pain relief the Drs today will generally make available to an OSA patient. I am really worried they will not give me adequate pain relief and then I won't be able to exercise as necessary in Physical Therapy. I can only get 4 weeks away from work so will need to work very hard to get back in shape, so will definitely need adequate pain control.
Thanks.

[bdp522]

OSA will not keep them from giving you pain meds. While on pain meds that might knock you out, they will have you on cpap. To do the therapy you need to be awake and OSA isn't an issue then.

Brenda

[sapphirerose]

My husband had back surgery, not knee surgery, and his surgeon gave him the patient controlled pain meds but not as much as they would have given a man of his size without OSA. You may find it is enough for you, you may not. It also may be a surgeon preference issue. My husband brought his machine to the hospital, and it was used in both recovery and in his room, along with the oxygen the hospital generally uses.

My father had his knee done. Make sure that they send you home with a knee bending device. My father's PT said that the therapy went more quickly once it started because the surgeon had sent him home with that device. He said that not every surgoen utlized it. My father never told me the official name, unfortunately.

[DocWeezy]

Congrats on getting a new knee! I've had two of them done; unfortunately, it was before my OSA diagnosis so I went through both surgeries and recovery severely sleep deprived.

Talk to your doctor and the hospital about pain management way before the surgery and make sure they get it all noted in your chart. Managing the pain is the MOST important thing for a better and faster recovery--I know because I had lousy pain management for my first knee and great pain management for my second knee (two different surgeons). If your doctor suggests something called a femoral nerve block, go for it because it is fabulous pain control directly to the nerve without having to take morphine. Having that in for a day and a half after the surgery made a world of difference.

Get yourself over to this site:

http://bonesmart.org/

They saved my sanity more than once! it's a site for both hip and knee replacement folks with separate forums for hips and knees. There is also a ton of information on it about the surgery itself, etc. The forum is moderated by a retired orthopedic nurse with decades of experience. LIke here, the people on the forum are willing to help....and it really really helps to know more about what to expect and the range of experiences out there. The button for the forums is kind of off to the right on the home page banner--not always real easy to find.

I got the best advice on aftercare pain control from the folks there, and learned a lot of other tips plus things I didn't want to hear (like it really does take a long time to completely recover).

My husband just had his hip replaced and spent plenty of time on the hip side of the forum and thank heavens for that--he's one of those who would have been out climbing on a ladder too soon and the tales of other hip replacements who did too much too soon kept him quiet. Whew!

Feel free to PM me if you'd like. Having a TKR isn't fun, but the results are SO worth it. My only regret in having my knees replaced is that I waited so long.

Weezy

[RandyJ]

I have wondered myself if certain narcotic pain relievers (oxycodone, hydrocodone, etc) are contraindicated for people with OSA, since they depress respiration...

Maybe there wouldn't be an issue with these meds during the day when one is awake (as long as one doesn't take naps), but if it is an issue at night then would one have to be sure that last dosage was mostly worn off before attempting sleep?

Or if one was taking it would one need more pressure?

Just wondering...

[chunkyfrog]

Congrats on the new knee.
My mom said it was life-changing--increasing her mobility vastly.
She complained about the pain during rehab, but they bunked her with such a whining crybaby,
my mother poured on the effort to get the H-E-double hockey sticks out of there FAST.

[DocWeezy]

I have wondered myself if certain narcotic pain relievers (oxycodone, hydrocodone, etc) are contraindicated for people with OSA, since they depress respiration...

Maybe there wouldn't be an issue with these meds during the day when one is awake (as long as one doesn't take naps), but if it is an issue at night then would one have to be sure that last dosage was mostly worn off before attempting sleep?

Or if one was taking it would one need more pressure?

Just wondering...

All I know about this is that I was on heavy doses of oxy at first, and then hydro for several months. I didn't know that I had severe OSA at the time. I survived, although now I shudder to think about what it did to my breathing during sleep. I think you need to take a lot more than the basic dose to truly start depressing your breathing to the point of serious trouble.

I think that overall if you have untreated OSA, taking those drugs will definitely worsen it; however, I don't think having TREATED OSA will keep a physician from prescribing them. I hope not--good pain control is vital.

Sleep is necessary for healing; pain control is necessary for sleep.

Weezy

[Pugsy]

I have wondered myself if certain narcotic pain relievers (oxycodone, hydrocodone, etc) are contraindicated for people with OSA, since they depress respiration...

Maybe there wouldn't be an issue with these meds during the day when one is awake (as long as one doesn't take naps), but if it is an issue at night then would one have to be sure that last dosage was mostly worn off before attempting sleep?

Or if one was taking it would one need more pressure?

I think it depends on the person and the dosage. It's not like the pain killers totally suppress respiration with the dosages offered as standard dose.
When I broke my wrist last summer and had to have surgical pinning to fix things I was given Percocet for pain management and yes I took it at bedtime because if I hadn't...it hurt so bad I couldn't have slept.
I was using the APAP machine at the time and other than maybe a little more variations in pressure than I normally would see...there really wasn't any huge difference in AHI or even overall average pressures.
Even after the first 3 or 4 nights when Percocet was no longer needed I still had some minor pressure variations which might have been related to sleeping on by back.

The variations were really relatively minor.. like my usual 90% pressure was around 12.0 and when taking the Percocet I saw 90% pressure maybe near `13 cm. A variance that I might have anyway from time to time and have seen without any opiate meds. So I can't totally put all the blame on opiates.
It sure didn't point to normally needing 12 cm pressure without opiates and needing 16 cm or whatever with the opiates and I am a small woman where one would think that I might see a more noticeable affect when given standard dose.

It's a typical risk vs benefits thing. Always best to discuss with doctor so that everyone is on the same page. If a pain pill lets me sleep....and costs me an extra event or an extra little bit of pressure...totally worth it. Let the machine do the job it was designed for.

[sandman19]

I had bilateral (both knees) total knee replacements the same day. I am sure I had SDB at the time but had not been diagnosed. I understand your concern.

Please talk with your anesthesiologist before surgery-many groups have a pre-surgery clinic. There are several peripheral and central nerve block that can decrease you pain level and decrease the need for IV/oral narcotics. A few of the options include: femoral nerve block (continuous catheter is much preferred over single shot), spinal narcotic (+/- spinal anesthetic) and epidural, single injection vs. continuous, narcotic vs. local anesthetic vs. narcotic & local anesthetic, vs. adding epidural anesthetic, etc. There are pro and cons to each. Your anesthesiologist will know these better than anyone else. Many institutions have their usual protocol which can be individualized for a given patient. These protocals integrate with the surgeon's choice of anti-coagulation post-operatively (decreasing the risk of blood clots to you lungs). Your anesthesiologist MUST know about your SDB, obstructive and/or central, your "PAP" settings as well as the rest of your medical problems. Post-operatively you may initially require a higher level of care due to your SDB. To be repetative, you must talk with your anesthesiologist about your medical problems and your concerns.

In reference to your post-operative P.T., you can talk with your physical therapist before surgery so they understand your diagnosis of SDB and your concerns. They can work with your surgeon who will be prescribing your pain medicine for when you are at home.

If the above isn't enough you can talk with your sleep doctor and/or respiratory therapist before surgery.

I hope this is helpful. "Good Luck"! (P.M. me for any further direct questions.)

Sandman19

[osako]

I had a 5 hour surgery recently to repair broken bones in the knee joint as well as ligament and meniscus damage. Got a bunch of hardware and bone grafts installed too. I also have OSA. The Drs. did not limit my pain medicine as far as I could tell. Good thing, because I needed a lot of it. They will probably monitor your oxygen level and give you oxygen if your levels are low. They did with me. That means, however, that they will have to connect the oxygen to your CPAP hose. Be prepared for that. Their connector for oxygen couldn't accommodate my slimline hose, so I wound up having to use a hospital mask and hose. The exhaust on those hospital masks is very, VERY LOUD and kept me up. Also, if you don't bring your CPAP machine with you they will give you one, but be sure to ask for a humidifier. I didn't ask on the first night and didn't get one. It really sucks having an intubation tube pulled out of your throat and then having a non-humidified mask on all night.

[Janknitz]

My father had his knee done. Make sure that they send you home with a knee bending device. My father's PT said that the therapy went more quickly once it started because the surgeon had sent him home with that device. He said that not every surgoen utlized it. My father never told me the official name, unfortunately.

It's a continuous passive motion machine--CPM for short.

Most people say the surgical pain goes away pretty quickly and the post surgical discomfort is nothing compared to the knee pain you have now. Ask your doctor how soon you can swap narcotics for analgesics like Tylenol or NSAIDS like ibuprophen. These are really BETTER pain relievers than narcotics--narcotics just make you not care. And be sure that the doctor prescribes a stool softener to go with your oxy--don't wait until after you're backed up!!! That's the biggest issue that can interfere with PT! Really!