RLS Meds & Post-Surgical complications

[Bganim1947]

I had a knee replacement a year ago. It went well, except my doctor took me off my Tramadol, 100 mg/3 per day, while keeping me on my 100 mg, 3x/day Pregabalin—it works well together. Instead he had me on 5 mg of Oxycodone every 4 hours. He thought the Oxycodone would an effective substitute for the tramadol. It wasn't! Within 3 days, I had full-blown RLS, plus I think I was going through withdrawal from the tramadol, because it was more like withdraw sensations, which I experienced getting off Ropinerol 5 years ago. I was in misery for 17 days while I was off Tramadol. Although the Oxycodone did take manage of my pain once he increased my dosage to 10 mgs (my doctor discovered that he had to give me more than 5 mg every 4 hours, because my tolerance for opioids was high due to 5 years on Tramadol).

Now I'm due for my second knee replacement, and my surgeon is reluctant to do the second operation. He said my medication needs are too complicated—out of his wheel house. How can he give me sufficient pain medication such as Oxycodone while also keeping me on Tramadol. I'm quite upset as I need that knee replacement now!!! A pain specialist recommended I go on Percocet with Tramadol, post-surgery. Surgeon is skeptical, because Percocet is just Oxycodone with acetaminophen and that's two opioids together, which he thinks is dangerous due to respiration suppression.

Any suggestions out there, please. What kind of pain relieving medication can I take while also staying on Tramadol? I take 300 mgs of tramadol (100 mgs 3 times a day). Increasing it to 400 mgs —the max anyone should take) isn't sufficient for the very painful knee incision recovery. I am at wits end. Help please?

[Madlegs1]

There's something more going on here, if 30 to 60 mg of oxycodone doesn't do the job?

What other medications have you been put on?

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Hi Bganim, you and I posted back and forth years ago when you were withdrawing from the DA. I suggested the ferrous bisglycinate to you which, as I recall, worked well for you until you were getting ready to come off, then you needed something much stronger than just the iron. I have found that to be the case with just about everyone on the DAs - works well until down to lowest dose.

Anyways, if it were me, I would ask my sleep specialist for Neupro while you’re in the hospital and recovery. Then when your knee is healed you can go back to your regular regimen.

[Joolsg]

It's so annoying that you were switched to Oxycontin when Tramadol worked well for you. Oxycontin is standard pain relief for bone surgery.

However, many RLS patients just don't get relief from it. I'm one of them.

It seems many people, especially women, have constant mini withdrawals. That's anecdotal but I've seen it in quite a few women on here.

You will clearly need pain relief to deal with the hip replacement and you need to have an in depth discussion with the surgery team

Do tell them about the Oxycontin not helping the RLS.

I wish I could suggest something but I'm stumped.

After surgery I would recommend slowly reducing Oxycontin while increasing tramadol but, bear in mind you will have to go through a tough few weeks while your body adjusts to Oxy withdrawal.

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This article is 10 years old, but is right on point for you. A friend’s partner has terrible PLMD and he successfully navigated thru surgery with Neupro. ncbi.nlm.nih.gov/pmc/articl...

[sylvanwanderer]

My husband is a medical doctor, and he says that tramadol and Lyrica (pregabalin) are quite sufficient for pain control after knee replacement surgery. He has several patients who have refused narcotics post-op that have done quite well.

[Bganim1947 in reply to sylvanwanderer]

That didn’t work for me. My tolerance for Pregabalin & Tramadol is already high from years of use for RLS. So it doesn’t touch the severity of the pain I experienced after the TKR surgery. It was the worse pain I’ve ever experienced. My surgeon took me off my Tramadol and had me taking 5 mgs of Oxycodone. I went into an RLS spiral on top of the surgical pain. Plus I was probably going through withdrawal from Tramadol too since he told me to just stop taking it.