I recently had cataract surgery on one eye. It was successful, but my surgeon told me afterward that it was very difficult. My RLS kicked in under sedation (even ketamine) so badly that at times my eye disappeared from her view under the microscope! She is unwilling to take chances with my other eye, so wants me to have general anesthesia for that operation.
Is there anything I should be aware of and speak to the anesthetist about prior to surgery?
Thank you for any advice.
Mountain Wanderer
Tell your anesthesiologist about your RLS and its symptoms and that you need your medicine and ask if there will be any drug interactions from what they will give you. Tell them not to give you any sedating antihistamines or sedating anti-nausea medications. Instead insist they use Zofran (ondansetron) for anti-nausea.
Thanks very much, Sue. I feel more confident having this information.
You might want to increase your medicine to make sure your RLS won' t be acting up.
Sue,I had the opposite scenario with a majot back operation my RLS stopped during the period of the operation and for about a month afterwards. When I asked the neurologist about this he said that the antibiotics which the surgeon would give me for such a major op would probably take sometime to come out of my system and hence no RLS (which returned after about 4/5 weeks) Personally i suspect it was the painkillers they pumped into me afterwards that kept it at bay. Do you have any experience of RLS and antibiotics and operations?
Kind regards
Davchar23
No I don't. You are probably right. They probably gave you opioids yo kill the pain and low dose opioids are used for RLS.
Were you taking the painkillers during the 4 to 5 weeks? The doctor is quite insightful. The antibiotic effect is probably true on two fronts. It eradicates iron loving bacteria so there’s more serum iron for our organs, including our brain. Also, by “quieting” the gut microbiome, our body sense less “invaders” resulting in less hepcidin. Less hepcidin once again means more serum iron for our brain and other organs.
As an aside, after antibiotics you want to try to avoid iron supplementation. It can negatively impact the return of a healthy gut microbiome. Not sure why, but supplemental iron, in general, feeds the bad bacteria in greater proportion than the good. So whatever doesn’t get absorbed in the upper gastrointestinal tract heads straight for those bad boys.
There’s been a lot of talk on here about maximizing iron intake. While I agree with maximizing “absorption” of iron supplements, I also believe in taking the lowest effective dose. NOT taking 6x the recommended daily allowance, as some people on here do. I personally need to take around 50mg of iron at night to quiet my legs. For a long time 25mg was enough. If I was simply trying to raise ferritin (and provided not anemic) then I’m just gonna take the RDA of the most bioavailable iron out there. So what if it takes a little longer to raise ferritin this way? I hate to imagine what hundreds of milligrams of unabsorbed iron is doing to our gut microbiome. If its feeding mostly the bad bacteria then the only thing those extra large doses of iron are doing is raising hepcidin and lowering absorption of future iron dosing.
Dear DesertOasis,
No i was not on any significant painkillers beyond 2/3 days after of what was a major spinal procedure. I am sorry but you "lost" me part way through your reply but i think you mean that there could be a link between relif from RLS and antibiotics? I had another lesser example of it more recently when i took an antibiotic for a leg infection and a similar thing happened. My GP has offered a trail on this but after i get through DA augmentation withdrawal. Regards David
Yes, antibiotics MAY relieve RLS via increased serum iron via a quieter, more behaved, gut microbiome. Be very careful. What doesn’t kill ‘em only makes them stronger. Those bad bacteria will rebound with a vengeance while our more delicate, good bacteria that keep the bad ones in check, will come back slower. Antibiotics AND iron are a double edged sword. I would love to be able to stop supplementing with ferrous bisglycinate. Alas, it is the only substance that relieves my RLS.
Thank you so much for your helpful comments. A final question please.... the "bad bounce back" means what ..... a bad stomach for a period of time or something more serious? Regards
David
Yes, initially antibiotics may cause diarrhea or even constipation, but I’m thinking more long term and bigger picture. I believe that our gut microbiome (actually microbes all over our bodies) is pulling most, if not all, the strings in our body. So having an “ideal” gut microbiome may greatly reduce symptoms of RLS. At this point in time we have no idea what an ideal gut looks like much less one that is likely to reduce RLS symptoms. With that said, I’m all for being good to our guts and hoping for the best. Antibiotics are not good. Fiber and probiotics are probably good. PLUS, our digestive system has a circadian rhythm all its own. It truly wants to go to sleep shortly after sunset and not be awakened until after sunrise. Many people on here report improved symptoms by not eating at night. Bottom line - though they may provide short term relief from RLS, antibiotics are waaay too disruptive in the long run.
Thanks I appreciate the time you gave to answering my questions
Hi ,I had cataract surgery done 2 months ago. The clinic I went to (in the UK) don't offer sedation and although I was a bit nervous beforehand I can honestly say I didn't feel a thing as numbing drops are put into your eyes it was 100% painless and unless there are special circumstances I can't see why you would need a General anaesthetic it seems overkill .I was in and out within an hour and the actual procedure only took around 15 minutes
She may need the General bec her RLS had her legs moving!! Even tho she was sedated!
It’s not over-kill if it means a guarantee of not moving during cataract surgery. Imo it’s absolutely reasonable and medically necessary based on what happened
Exactly. Thanks.
I misunderstood the post and thought it was the sedating med that had caused the bout of RLS as many are triggers .No need for the exclamation marks it makes the tone of your comment snippy when I was only trying to help
Sorry I didn’t mean to sound snippy. I do actually speak as if with exclamation marks in my everyday speech. It’s my normal voice and not intended to cause offence, but emphasise my emotion.
I have cataract surgery on the cards and RLS movement during surgery is a worry. Some surgeons are insisting I’m under general and some say it won’t be a problem.
It’s an emotive topic.
Again no offence intended, yet ppl may feel uncomfortable with my tone.
I can only offer an explanation.
xj
Hi thanks for your reply I understand I was having a bad day so maybe I overreacted. I hope your upcoming surgery goes well
No worries. Lots of ppl tell me I sometimes sound over the top. So this one is on me 
xxx
And thx re good wishes for surgery. Unfortunately mine is esp high risk as I’m basically monocular. Still I’ll hold on to your kind thoughts for when and if they give me the go ahead.
so many are going through tough times and I too have many bad days.
So grateful for everyone here xx
We all have bad days, right? I hope you're having a good one.😉
Thanks, but you were lucky. I was not because of the continued movement of my legs during surgery.
Sorry I misunderstood I thought it was the sedation that had caused the bout of Restless Legs during a op as many meds used for sedation are a trigger.Best of luck for your op
thank you
I’m glad your fist op was successful.
That’s most important.
If there’s a risk of your rls ‘kicking in’ again I wd agree with surgeon — and have the general. Why risk it?
I also agree with Sue Johnson about Ondansetron if an anti nausea med is necessary.
Best wishes
Thank you.
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