A look into the drugs used post op ACL reconstruction and its effect on the physio. Now i know!
When the physio becomes the patient – what I learnt week 1 post ACL reconstruction and meniscal repair.
OH THE PAIN!
As a physio in private practice we see a patient sometime 1 but usually 2 weeks post op ACL reco. To put it in perspective, I have not seen a day 0-7 post op since I was first year student on placement almost 9 years ago. Funnily enough, it was at the same hospital with the same surgeon I watched perform an ACL reco as a very fresh inexperienced student all those years ago.
What was done and the immediate care in hospital was nothing new to me. There were a few minor differences to 9 years ago, which made me glad not to be in orthopedics cause I would be bored as hell doing relatively the same thing for 9 years.
However on leaving hospital I was given a $100 bag of drugs, my post op orders and sent on my merry way. Day 1 was a high, 10ug/hr Norspan patch, 10/5mg Tagin BD (twice daily), 4 hourly 10mg endone, Paracetamol QID (4/day) and Proxen (NSAID) 1000mg SR mane (morning). It was a fairly decent experience!
The pain was uncomfortable for 3 days. In no way being stoic, it was sore but luckily I had well managed pain and it was relatively low compared to the pain experience I have heard others have suffered post ACL reco.
After 2 days, I made a decision to reduce my opiate intake. Having worked in pain management for 5 years I knew I needed some form of pain relief on board post op and had a good idea of how to reduce it. So I ditched the Targin, remained on the Norspan patch and reduced my Endone intake to 5mg PRN (as needed, 2/day, which was at night for sleep as bad sleep increases pain experienced the next day by 10%. I also continued anti-inflammatory (NSAID) and Paracetamol use as I had a ball instead of a knee. I did however begin to experience some gut issues from the Proxen and recognised this early, changing to Celebrex which is a NSAID milder on the gut and this ceased any problems from there on.
After another 2 days I was sitting on the couch feeling awful. The pain was very minimal, but the effects of the drugs were kicking in. My mood was short and the nodding off giving me the shits. Being in little pain, I didn’t need drugs so I cut the Endone in the morning, wow! Within 2 hours I was having withdrawals. Sweats, shakes and agitation. I couldn’t believe in a short period of time, with not taking that much how reliant my body was on an opiate and that it had become somewhat addicted. By the afternoon I had normalized. Still with an opiate, Norspan patch on board.
The next day, day 5 I took off the patch. Again withdrew further. It was a great experience. In 5 days I had experienced what many patients had described as hell when coming down off opiates. But in my situation it was a few days. Usually they are on very high doses for very long periods of time where the withdrawals are heavier and longer lasting. So a huge respect to them, empathy and support in future if I suggest weaning down off opiates for persisting pain. By that afternoon I was feeling GREAT! No pain and a clear head since day 0.
So that is the drugs, there were many other methods I used for pain management in the time. I will touch on these in part 2 in a few days!