Question:
Post Op Meds for knee replacement

Hi Everyone. I had gastric by pass last August 2008. Two weeks ago I had knee replacement surgery, and all has gone pretty well, but I have so much pain and the meds they have given do not seems to help enough for me to even get through my physical therapy. I am on Oxycontin, and Oxycondon (spelling?) I am scared to take Vicodin as it is so constipating. Can anyone help? I don't seem to be getting much help from my Orthopod. Do you think I am mal-absorbing? Please any suggestions are welcome on how to handle this. Peggy    — katiecakes (posted on February 23, 2009)

February 23, 2009
Good Morning Peggy... I'm heading your way soon for a TKR, I've been taking Hydrocodone which has worked very well and much easier on me than Vicodin, which never agreed with me before my RNY. It comes in liquid and pill form and the pills are actually not hard to swallow. Hope that helps. ~Kristina
   — Dlfngrl05

February 23, 2009
Yes you are mal-absorbing. You might try Fentanyl transdermal patch when I broke a bunch of ribs it was the only thing to help. You wear it for 3 dys and replace. Have your othro talk to your wls doc if he doesn't get it.
   — dc10pilotswife

February 23, 2009
you have approx 80% malabsorption- its like cutting your pill into 5 pieces with a normal person, then taking 1 small piece of the 5 ) and we all know that is not going to take the pain away. All pills need to be ground up before taking them. All capsules need to be opened into liquid- about 1 oz, than drank. Get as many meds in elixir form as possible. I have been working on this matter for 4 years and talking with over 1042 post op rny patients with their pain, birth control and depression med dosing problems. Your first line of defense is making your doc understand in meds one size does not fit all, especially as u have no stomach, just a pouch and a chit load of malabsorption. I am ready to write all the rules down and post them. good luck Cindi m.d. retired, almost 5 yrs post op -230#
   — DollyDoodles

February 23, 2009
Ask your dr about liquid Loratab (Sp?) It works great for me.
   — phyllismmay

February 23, 2009
Hi, Peggy. Sorry to hear you are having so much trouble. My only suggestion is that you inquire about liquid pain killers--maybe the oxycodone or percocet can be given as a liquid?? I had my lapband surgery in August 2008--so we are on the same time frame. I had double hip replacements 4 years ago--I am glad it went in that order, after hearing that you are having trouble absorbing the meds. Hang in there! You are on your way to a new and improved you! Nerna 50
   — nerna50

February 23, 2009
Percocet does come in a liquid -- it's called roxicet and, at least in my case, works great!
   — dnoreenh

February 24, 2009
Hi Peggy, I had knee replacement 3 years ago, and the immediate post op pain was unbearable. Finely at about 4 am the next morning, the nurse called the Doctor and I was given Tordal (sp). On a pain scale of 1-10, 10 being the worst, I was a 12. Within a few minutes after I was given the drug, I was down to about a 5. They call Tordal super Tylanol, but they have to be careful with it because it can be bad for your liver. I've been told it works on the pain in the bones. When I had foot surgery 8 months later, I relayed this information to that surgeon and he told me that with every surgery He does, before the patient leaves the OR He shoots around the affected area with Tordal. I had no pain with my foot surgery. My 85 year old mother-in-law had knee replacement and never had any pain because her surgeon also shot around the knee before she left the OR. It does come in pill form, but if you can get your ortho-doc to give you a shot, it would work much better. Don't give up on your ortho-doc, remember the squeeky wheel gets the grease. Good Luck, Paula B.
   — paulajaneb

February 25, 2009
Knee replacement hurts... sorry you are in pain. I hate to break it to you... oxycontin / oxycodone cause constipation too. All narcotics do. Increasing your fiber intake and a stool softner can help prevent it. I don't think that malabsorption is the same with food as it is with medication. We absorb most food/nutrients in the small intestine so if you shorten the small intestine, you absorb less food. Medication, however, can be absorb through the entire GI tract, from the mouth (ex. sublingual meds like nitroglycerin, transbucal meds like actiq) to the rectum (ex. suppositories meds like phenergan, morphine, tylenol, etc.). My suggestion... take the Vicodin. I would also suggest talking to your physical therapist and asking for medication free ways of relieving pain. You also might want to ask if the amount of pain you are having seems normal and if not, perhaps they can help advocate for you with the ortho. You could also contact your primary care doctor and see what s/he thinks. Good luck and hope you feel better!
   — mrsidknee

February 28, 2009
I had TKR in 2007 and the liquid lortab helped me very much with the pain. I was also given tablets of higher dose so when I went to therapy...1 hour before going I would take the tablet. By the time I got to therapy and gotten started the meds would have kicked in. Made me a bit sleepy but worked fine. I have RA and I take darvocet for pain nights. Constipates me but use of a stool softner does fine for me. Oxycontin throws me for a loop and I do not take it if dr reccomends it.
   — mspisces

March 4, 2009
Hi Peggy, I'm a Registered Pharmacist. OxyContin is a continuous release product and it won't work correctly for you because of the way it breaks down in the body's gastrointestinal (GI) tract. Oxycodone immediate release tabs should work - like the previous posters said, crushing it might help it absorb better. Vicodin/Lortab/Hydrocodone are basically the same thing - they are not as strong as Oxycodone or OxyContin, but they do make a liquid form. All of these drugs are opioids and can cause constipation, especially if used consistently. I recommend taking Docusate 100mg twice daily (stool softener) while you are on the pain meds. Another option for pain control might be Celebrex (it has anti-inflammatory effects with less GI effects than others such as Ibuprofen or Naproxen). Using an anti-inflammatory plus a pain med (like oxycodone) might be more beneficial due to affecting pain with two different pathways. Good luck.
   — NMlakerFan

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