operation

[Hublot]

good morning, I’m having a foot surgery on the 27th February, after surgery the only pain killer I can take will be codein I am able to take my pregabalin anything else could stop the bones fussing together.

For the first 2 week I cannot weight bear. I will be in plaster then have a boot, I’m

Very worried about how the medication will affect myRLS, I wake up early hours have to move around the house then I can go back to sleep . This is going to be nearly impossible, in those first 2 weeks. Then it’s moving around on crutches, I don’t want to become addicted to this medication.

[SueJohnson]

For your surgery tell your doctors and anesthesiologists 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. Also talk with the patient representative ahead of time. Tell them not to give you any sedating antihistamines or sedating anti-nausea medications. Instead insist they use Zofran (ondansetron) for anti-nausea. You can download the Medical Alert Card that you can show your doctors, that tells them about the condition and what will happen after surgery and what medicines to avoid at rlshelp.org/ although you will need to join the RLS foundation. An international membership is $40, but they have some good information on it and you get their monthly magazine. However the safe antidepressants listed on medical alert card are not antidepressants: Lamotrigine, Carbamazepine, Oxcarbazepine. Also there is a 2 page handout "Surgery and RLS: Patient Guide" on the RLS Foundation website which is very helpful. Also "Hospitalization Checklist for the Patient with RLS"

After your surgery your RLS may get worse for several reasons - inflammation from the surgery, withdrawal from any opioid they gave you and if there was blood loss your ferritin may have gone down. All of these are temporary but may take awhile to go away.

Are they giving you codeine for the surgery or some thing else?

For your RLS afterwards do take as much codeine as you need. According to the Mayo Algorithm 60 to 180 mg is the usual effective dose. If the codeine doesn't work I suggest you ask for a prescription for a few tablets of the DA you used to take. You can take it 3 times a week without worry of having to withdraw from it again. And you probably could take it every day for a week or two again without worrying about withdrawal.

[ziggypiggy]

I wouldn't worry to much unless you have a history with addiction issues. Codiene is on the weaker end of the opiod spectrum. Also, your supply will be restricted by your doctor. I think you will be thankful for the codeine. You have a healthy fear of addiction which is a good sign. I hope the surgery and recovery goes well.

[Hublot in reply to ziggypiggy]

Thank you so much for your reply, has put my mind at rest.

[Joolsg]

Dr Winkelman's opioid study shows that addiction doesn't usually happen when taken for RLS and we don't need to increase the dose.You will find the codeine improves your RLS and will likely stop you waking up to move around.

Clearly pregabalin isn't covering your RLS (you say you wake up with RLS & have to move around) so adding codeine long term may actually improve your RLS dramatically.

When you are recovered- you should be able to reduce the Codeine without any side effects.

And, as Sue points out- you need to ensure a safe anti nausea is given with the anaesthetic and that the hospital gives you your meds on time.

Good luck.

[Niewiem]

I see SueJohnson gives you all what you need. But if you want to keep simple and I've been there, to ask a hospital to change what they normally do, o boy you are on a mission of impossible. What I did just stick to tramadol, cuts it all and they had no problem with it, Bring your own as well to beef up when needed, cheers and good luck, N