Question: ACL surgery this Thursday... pain management tips?

[Kerryn]

Hi,
well, got back from Japan just over a month ago. Saw OS, confirmed ACL totally torn, and surgery scheduled for Thursday10th March.
I've been prehabing madly, going well but not same as good knee yet but PT very happy with progress ( acupuncture has been great).
As surgery gets close I'm getting a bit concerned about post-op pain. If any one has any suggestions as to how to cope/manage pain in those early days I would be very grateful. I am very positive and optimistic, already thinking about next years snow trip... although surgeon and hospital will probably get all the holiday funds:(
Any thoughts would be appreciated.
Kerryn

 

[altagirl]

First, realize that icing and elevating are very effective on their own, but beyond that, if you deal with the pain killers well, stay on schedule with them. If you are relying on pain killers and wait until you are in pain, instead of taking them every so many hours as prescribed, catching up is not fun.

My personal experience is that the amount of pain is directly related to the amount of swelling. So if you do a great job with the icing and elevating - keeping the knee above your heart whenever you aren't up to go to the bathroom, you will be in a lot less pain and my experience is that you might not need much in the way of pain killers. But I'm sure it varies person to person and surgery to surgery as well. Graft type also makes a difference, I think.

 

[marge]

I agree. Do not get behind the pain, stay on top of it.

I highly agree with the ice and elevation as well. Keeping the swelling to a minimum will make it more comfortable just on it's own. I hope you find that the pain is not too bad.

 

[Pequenita]

Hi,
I am very positive and optimistic, already thinking about next years snow trip...

I think this will go a long way, too.

People do have different thresholds of pain, and my understanding, like Altagirl's is that the graft matters (if you have an allograft, there's only one incision/procedure - at the reconstruction site only; if you have an autograft, you're effectively having 2 procedures - one at the harvest site and one at the reconstruction site).

Best wishes.

 

[pinto]

My husband had ACL surgery last Tuesday, and he's had basically no pain. The doctor gave him 6 oxycontin, two a day for the first few days, and then vicodin for breakthrough pain, which he never had. (Of course, as a kid he went to a dentist who didn't use a lot of painkillers, so I think he's all toughened up.) He used the oxycontin, stayed on top of it.

So, I hear it can vary like this. Some people get a lot of pain, others don't. He had a hamstring graft. He feels pressure, but not pain. Hopefully you'll be like that.

Good advice on keeping the swelling down. The first day, you'll be on a nerve block, and you definitely won't feel much. DON'T BE ACTIVE, even thought you might feel like it. It's harder to be up and around anyway, with your brace and dressings, but if you are, you'll increase the swelling.

Good luck!

 

[Kerryn]

Thanks Altagirl and Marge re- icing/ swelling / pain. I know when you suggested leg above heart level before Altagirl it made quite a difference. Good to know that the amount of swelling is related to pain Good advice goes a long way.
Thanks too Pequenita and Pinto. I'm having a hamstring graft as well Pinto, fingers crossed I'll be like your husband and have little pain...think I might remember the name of those painkillers to ask doctor about though.
I'm feeling more positive after reading your posts.

Thanks!!
Will let you know how things .

 

[Swamp Dog]

just like what has been said...stay ahead of the pain. Don't think you're feeling ok and skip the pain meds, no need to be a hero after surgery.

Wishing you a speedy recovery!

 

[Kerryn]

Thanks Swamp dog, will do .

 

[altagirl]

think I might remember the name of those painkillers to ask doctor about though.

FWIW - I've never had oxycontin, only percocet or lortab (oxycodone).

It is probably worth asking what they prescribe for pain management, but I'd be worried that if you go in asking for oxycontin, they're going to think you are a drug addict (since it's fairly notorious for that).

Things to ask your doctor would probably be - what is the plan for pain management (some will leave in a pain pump, though I've never had that). What meds do you prescribe? What should you watch for to know if you aren't reacting to them well? They probably tell you all that after the surgery, but you'll be in a fog, so it's good to discuss beforehand if it's your first time with this.

 

[pinto]

FWIW - I've never had oxycontin, only percocet or lortab (oxycodone).

It is probably worth asking what they prescribe for pain management, but I'd be worried that if you go in asking for oxycontin, they're going to think you are a drug addict (since it's fairly notorious for that).

Oxycontin is the same drug as oxycodone, it's just the time-release version. (Easier to keep up with the pain meds if you only have to take one every 12 hr as opposed to 4 hr, ie, you won't have to wake up in the middle of the night)

They only gave him 6 tabs of it, by the way, good for the first 3 days, so yes, apparently there are concerns about abuse.

 

[Swamp Dog]

they won't think you're a drug addict asking for specific meds right before surgery. Lots of people know what works for them and what doesn't. Would be different if you were just in off the street complaining of random pain, but not pre-surg.

 

[altagirl]

they won't think you're a drug addict asking for specific meds right before surgery. Lots of people know what works for them and what doesn't. Would be different if you were just in off the street complaining of random pain, but not pre-surg.

I guess I just see a difference in how it gets worded. It just sounded like "My friend told me I need to ask for some oxycontin" sounds like it might raise an eyebrow, even in relation to surgery - considering I've had 5 knee surgeries now and have never gotten (or needed) anything that strong. (though I'm sure it's in the dosage more than the name of the drug). And I'm assuming she doesn't know what she's going to need/what works for her or she wouldn't be asking the question.

Whereas having a discussion about "I'd like to know what you plan to prescribe for pain management so I can check around and make sure none of my blood relatives tend to react badly to it, etc." or "I don't know what to expect, so what will we do if the pain meds aren't helping?" sounds more like you're interested for medical reasons.

 

[Kerryn]

Quote
It is probably worth asking what they prescribe for pain managment, but I'd be worried that if you go in asking for oxycontin, they're going to think you are a drug addict (since it's fairly notorious for that).

LOL I hadn't thought of that Altagirl. Yes , a better way to go would be to ask what they provide first , rather to ask for the heavy stuff up front. Will add that to my list of question in my pre-op consult.

 

[Pequenita]

My MD prescribed all my pain meds, including oxycontin, in advance, and the oxycontin in particular, I had to call in to the pharmacy in advance (48 hours? 24 hours?). If that was not a US law, it was definitely a Massachusetts law. Not sure what the laws are where you are... Also, pick up some laxatives as narcotics cause constipation. I didn't need to ask about any of this -- it was just prescribed to me at a pre-op appointment.

I think one of the most annoying post-op things for me was that they had done such a good job of hydrating me in the OR that the first few hours post-op, I had to constantly get up to the bathroom. So much for "rest." But do try to set yourself up in a space where possibly everything you could need is super accessable.

 

[persee]

Indeed. Ice and Elevation and any anti-inflammatory they say you can take to keep the swellling down. Also as others have said don't play hero with your pain meds - take them religiously to start. Sleep is important as the body needs rest to heal, if you are in pain you won't sleep. Also get used to your sleep being more "naps".

I had the good fortune to have had 3 wisdom teeth out only a few years ago, with an oral surgeon who prescribed percocet. Which I discovered I *hated*, so I requested vicodin for my ACL. I also had a drug intended to keep nausea down (and when taken with the vicodin it helped with pain as well). Slowly ween down when you're sure you're ready.

One other thing that I think was great for helping the swelling and discomfort in my knee was the CPM machine. It will seem like a hassle, but it's a hassle you should welcome. And when you're on pain killers you could even nap while on it! :P What it does is moves the joint in a controlled, non-exerting or stressful way which helps to move any fluid out, and also keeps scar tissue from building up. It can be used to gradually increase your range of motion post surgery so you'll be in better shape that way sooner since you won't have to use your muscles which will be feeling weak and sore (particularly your hamstring since you're doing an autograft), to get that nice healthy motion back.

 

[Daria]

I know everyone is different...I had my ACL reconstructed in 2004 and really didn't experience much pain. I was religious about icing and elevation tho. I had a "cold machine". You wrap it around your knee and it hooks to a pump that contains ice water so your knee is constantly being bathed with ice water. Not all doctors prescribe it but it really helped me. I would load up the ice bucket before I went to bed and sleep with it running. You just need to be careful not to wrap it too tight.

Good luck!

 

[altagirl]

I know everyone is different...I had my ACL reconstructed in 2004 and really didn't experience much pain. I was religious about icing and elevation tho. I had a "cold machine". You wrap it around your knee and it hooks to a pump that contains ice water so your knee is constantly being bathed with ice water. Not all doctors prescribe it but it really helped me. I would load up the ice bucket before I went to bed and sleep with it running. You just need to be careful not to wrap it too tight.

Good luck!

That's one thing I would get myself it if wasn't prescribed. The CPM - some doctors see value in them and some don't like them (the controversy being it helps increase mobility and range of motion - BUT full extension is the most important part in most people's eyes, so some doctors prefer you to rest the leg in full extension to make sure you are getting that first.)

But I can't imagine living without an ice machine - they go under different names - Iceman, etc. Do ask if you're getting one of those - if not, I'd cough up the money and buy one. A couple times waking up during the night needing ice and $150 wouldn't seem like a bad price at all. Basically what this is is a small ice chest that you add water to and then it pumps ice water through a pad you wrap around your knee. Lasts for 7 hours or so at a time. Aaahh.

https://www.betterbraces.com/donjoy...ftrk=gdfV21180_a_7c405_a_7c1427_a_7c11_d_0494

 

[pinto]

That's one thing I would get myself it if wasn't prescribed. The CPM - some doctors see value in them and some don't like them (the controversy being it helps increase mobility and range of motion - BUT full extension is the most important part in most people's eyes, so some doctors prefer you to rest the leg in full extension to make sure you are getting that first.)

But I can't imagine living without an ice machine - they go under different names - Iceman, etc. Do ask if you're getting one of those - if not, I'd cough up the money and buy one. A couple times waking up during the night needing ice and $150 wouldn't seem like a bad price at all. Basically what this is is a small ice chest that you add water to and then it pumps ice water through a pad you wrap around your knee. Lasts for 7 hours or so at a time. Aaahh.

https://www.betterbraces.com/donjoy...ftrk=gdfV21180_a_7c405_a_7c1427_a_7c11_d_0494

Yes! These things are great. I'm a CPM believer, too. When I first used one, though, they had me in it 10 hr a day at first. That was kind of awful. Luckily, a new Tom Wolfe novel had just come out....

 

[pinto]

I know everyone is different...I had my ACL reconstructed in 2004 and really didn't experience much pain.

Curious about this, did you have the surgery soon after your injury, or did you wait a while? (Wondering why DH had so little pain.)

 

[altagirl]

Curious about this, did you have the surgery soon after your injury, or did you wait a while? (Wondering why DH had so little pain.)

I had a TON of pain with my first one and almost no pain with my second one.

The difference, to me was swelling. The first one - I stayed in the hospital overnight and they didn't really elevate my leg. It was just lying flat in bed with me sitting up, resting my foot on one pillow. I didn't know any better and continued more of the same at home. By the time I went in for physical therapy in a couple days it was HUGE. And solid black and blue from hip to toe. And hurt for months. This one was over a year between the initial injury and surgery.

Second time around on the other knee - I knew better. I woke up and asked for 3 or 4 more pillows to put under it. Got home and elevated it above my heart unless I was up to go to the bathroom or get food/ice/meds and voila - no big deal at all. This second one was about 3-4 weeks between injury and surgery.