June, 2007

IN LATE 2003, I had my first total knee replacement under spinal anesthesia. Soon after surgery, I was hurting. Despite substantial doses of morphine, my pain was a 10 on a scale of 1 to 10. Even at rest, I was very uncomfortable. I had to take narcotics for a month to deal with my knee pain, making me feel “fuzzy” and sleepy. The drugs definitely hindered me from focusing on the exercises I needed for recovery.

Three years later, I had my other knee replaced. I also had spinal anesthesia for this procedure, but this time I also got a little something extra. My anesthesiologist gave me a continuous femoral nerve block, which stayed in for two days after the procedure. What a difference! I was up and walking the first post-op day. My pain was zero at rest and during activity. I needed no morphine; after the procedure, I took acetaminophen plus hydrocodone for just 10 days, and I didn't take much. To be fair, my second procedure was less invasive due to a smaller, quadricepssparing incision, but I believe the peripheral nerve block prevented the pain from ever escalating in the first place. I can honestly say that I had virtually no pain the second time around, and I felt I was better equipped for rehab.

This turned out to be quite fortuitous. As luck would have it, I landed back in the operating room just one month after my second TKR to undergo open-heart surgery, and the fact that I was already functioning well with my new knee expedited my recovery. You see, the reason I received spinal anesthesia rather than general anesthesia for my two TKRs was that I had been experiencing atrial fibrillation for several years, off and on. Soon after my second knee replacement, my doctors discovered why. There was a tear in my mitral valve. In the OR, the physicians patched the tear and performed a MAZE procedure to normalize my rhythm.

Now, just four months later, I feel better than I have in a very long time. I have significantly more energy and no knee pain for the first time in decades. I am back teaching third grade. I am taking week-long trout fishing trips in California's beautiful Sierra Nevada mountains. I'm riding my bike again, and I am working around the house.

Several years ago, I thought my chronic knee pain and fatigue were simply part of getting old. Now, at 62 years young, I am very happy to be proven wrong. And while I hope I'm finished with doctors and hospitals for a while, if I ever have to do this again, I will choose a continuous peripheral nerve block in a heartbeat.

Mr. Shellard underwent his second total knee procedure at Tahoe Forest District Hospital in Truckee, Calif., and received his continuous femoral nerve block under the care of his anesthesiologist, Alar Saaramets, MD.