Surgery and RLS

[MATTIELUKE]

Has anyone with RLS ever had foot surgery or knee replacement? How did you fare?

[Jules1953]

Hi , in January 2018 I had full knee replacement surgery on my right knee. This was not performed under GA , instead a spinal block was used. The surgeon made a point of telling all those involved in the surgery , that they needed to be aware that I could hear everything that was being said and they needed to be careful what they said. Everyone was wonderful and I felt very supported.

The reason I was asked to consider this method, was because I needed to be up and walking the next day.

I was the only patient that day that chose the spinal block option. It was a 3.5 hour surgery.

An interesting experience.

I have suffered with a severe case of RLS for 50 years. At the time of surgery I was taking Sifrol (Pramipexole) medication for my RLS. Interestingly enough it was during my time in Hospital after my surgery, that I was asked by the pharmacist, why I was taking 3.00mg of Sifrol each evening to treat my RLS.

The pharmacist informed me that this dosage was well above the recommended dosage for treating RLS.

I was not aware that the maximum recommended dosage is 0.75mg Sifrol.

I was also not aware of what augmentation on this drug was all about.

After a few days in Hospital I returned home to recover from my knee replacement surgery and I also made the decision to commence, very slowly weaning off the Sifrol.

I spent two years slowly withdrawing from the Sifrol medication.

Some of the pain relief medication that was given to me after my knee surgery was Endone 5mg (oxycodone ).

I had some unused Endone tablets from my surgery and discovered that they were extremely helpful in assisting me in the final stages of weaning off the Sifrol.

I now use Temgesic sublingual 200mcg tablets to control my RLS.

Sifrol (Pramipexole) is no longer considered an immediate, "go to drug" for treating RLS. I wish our Doctors and Neurologists here in Australia would get this message.

I took it for approx 10years.

I suffered with augmentation, a shopping addiction, put on 30klgs and suffered with anxiety and depression.

Kind regards Julie McGowan from Western Australia

[Woody4 in reply to Jules1953]

I recently found an FDA report that stated that there is no benefits in taking more than .5 mg of pramipexole for RLS. My neurologist wanted me to take 1 mg of pramipexole 3 times a day. That’s 6 times the recommended dailey dose

[Jules1953 in reply to Woody4]

Hi, you are very wise not to take anymore than 0.75mg of Pramipexole in a day. Or as you mention 0.5mg of Pramipexole. I was not aware at the time of taking Pramipexole that I would end up experiencing augmentation. My Doctor did me a great injustice when he kept increasing my dosage, when I told him it was not being effective in controlling my RLS.

It is good that you are doing your own research as most Doctors do not know about treating patients with RLS.

Manerva, who is on this site is so very knowledgeable and helps so many people who are having issues with various medications they have been prescribed.

Also the specialists at the John Hopkins Medical Center in America are at the forefront of helping people from all around the world with their research into RLS.

Kind regards Julie McGowan from Western Australia

[Hidden]

I had two total knee replacements: 2017 (right) and 2018 (left). I made sure each anesthesiologist knew the restrictions on anti-nausea meds for people with RLS. I always demand Zophran.

The first one insisted he & the pharmacist knew better, and because I was too groggy to ask for specifics when handed pills, I accidentally took one I shouldn't have and wound up with both legs jerking within hours of surgery! But oxycodone quieted that fairly fast.

I had a spinal block with each. The surgery went fine, and both "pre-hab" and rehab PT helped me regain function very quickly. It's fantastic to be pain-free.

At the time, I was taking 30 mg of methadone for the RLS. It was largely successful, apart from some breakthrough jerking for which I took gabapentin.

The orthopedic surgeon prescribed both Tramadol and Oxycodone. Both also help a lot with RLS, but when they wear off you get a major rebound of jerking.

At first, I took the oxycodone every 4 hours to stay ahead of the pain, per doctor's suggestion. As the pain faded, I spaced the oxycodone out longer (5 hrs. 6, 8, etc.), and took Tramadol instead. I was careful to slow the Tramadol down gradually too, but still got quite a bit of rebound jerking. For that I took Gabapentin, but of course it was very uncomfortable!

I wound up with a few leftover Oxycodone and Tramadol pills. They were helpful a year later when I had thumb joint replacement surgery on one hand after the other--that doc does not prescribe oxycodone.

[HardyT81]

Yes I have had several broken bones in my right leg and left foot. And maybe it's because of that. But overall I think my opioid use is more likely why I have this problem to.

[MATTIELUKE in reply to HardyT81]

thanks

[B534967]

I had foot surgury last year and at the time was taking 1.5 Ropinirole nightly. I had no problem the day of or following the surgury. I am now (thankfully) off Ropinirole and taking two 800 mg Gabapentin in the evening - 1 at 8:15 pm the other at 9:15 pm and am doing fine. Hope all goes well for you. B534967

[MATTIELUKE]

Thank you!

[Pennyfarthing]

Hi I had a total right knee replacement in February this year by spinal block. I was already on oxycodone following withdrawal from pramepexole.The 2nd night I had to get out of bed due to RLS but I had warned the staff prior re my condition. They gave me a one off high dose of a relaxant, I can’t remember the name and I calmed down. I was already on oxycodone due to withdrawal from pramepexole

Interestingly since that time I have not had RLS in my right leg.

Good luck

[MATTIELUKE in reply to Pennyfarthing]

Thank you!!

[lorrinet]

I had total knee replacement surgery on my right knee 13 years ago. I've taken an opioid for over 20 years for RLS, and the only thing I've noticed about it is that if the RLS kicks off before I take the meds it can be especially intense in the area of the knee replacement. Not that it always begins in my legs, sometimes it starts in a foot, or a hand even, before being controlled by the drugs.

Incidentally, I had my knee done in my late 50s, and I've often wondered whether all that violent kicking out of my legs night after night over decades had anything to do with the need for that surgery.