4 days after PKR can I take nefopam and Tramadol

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Hi I had a partial medial left knee replacement 4 days ago. My second the right is now 8 months old. I know every knee is different and this one has also been scoped and straightened as I was 13 degrees bow legged. However I am really struggling with the pain. As well as the knee it seems to be my shin and more especially my lower back giving me the most trouble. Any one else experiencing this?

I am very sensitive to morphine and opioids in general being very sick with them, however last time I did seem to be slightly better with Tramadol. I came out of the hospital with Nefopam and paracetamol to take 3 times a day. This is not enough it hardly takes the edge off. I would like to know if I can supplement this with Tramadol as I have some left from before. (I came off it as soon as I could). Until I can get an appointment with the doctor your help would be appreciated.

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7 Replies

  • Posted

    If pain is that bad, contact hospital for advice or if in UK NHS helpline.
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  • Posted

    Hi. I'm 5 weeks post PKR. I was given nefopam and codiene. I was told nefopam is good as it doesn't interact with any other drug. At I've point they gave me nefopam, codiene and paracetamol all at the same time. I'm sure it will be fine, but call a pharmacist to double check. They will know. Hope pain improves soon. X

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    • Posted

      Thank you Debs. You would think I would know what to do as its only 8 months since the other knee. But, I think it was all just a blur of pain for the first five weeks. It was the GP who prescribed Tramadol last time as codeine makes me very sick. It certainly seemed to help especially before physio. They were keen I come off it as soon as possible so I have some left. Came home yesterday with five days of Nefopam and of course the doctors are not open until Monday. So I thought I would try and help myself but you never know what the interactions are.hope your knee is doing well, my other one took three months to settle down with good range of movement. At three months I went on a long haul flight and a sightseeing tour which had been booked a long time I one month I walked 102 miles although some were with a stick and not much pace but nevertheless better than it had been for a couple of years.

      Ideally I would have waited for full recovery before having the left one done but I tore the meniscus and my knee kept locking so I literally couldn't walk at all. So here I am doing it all again having forgotton all the rules and actually how bad it is. 

      At least we can both look forward now to an active life (I hope😏wink good luck x

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  • Posted

    Or you could call the hospital ward. They will be happy to advise. X
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  • Posted

    I know how you feel.  I'm very resistant to opioids.  With me, 10/500 X 2 of Percocet plus 10 mg X 2 of Flexeril every 6 hours only took the edge off.  Try some Voltaren Gel (RX in the US)...GREAT topical anti-inflammatory especially at bedtime...but that won't help with the systemic pain.

    Tramadol is still "technically" an opioid, though a lot less powerful than hydro- or oxy-codone (Vicodin/Norco, Percocet/Oxycontin) and definitely a step down in pain relief.  Usually used as a transitional drug between the heavy-duty opioids and plain ibuprofen.  There is also Tylenol-3 or -4 which is acetaminophen plus pure codeine.  We all react to meds differently.  It's really trial and error until you find the right combination that works for you.  Have your doc try something different, increase the dosage or shorten the timeframe (6 hours to 4).  Lots of leeway to find your "sweet spot".

    There is no US equivalent to Nefopam.  The research indicates that 20 mg of Nefopam is the pain-relieving equivalent of 12 mg morphine...it's pretty powerful stuff.  Unless you are on any anti-depressant or MAOI, there seems to be no warning of the combination with Tramadol but make your doc confirm that.  Mixing meds without doing the research is a very baaaaaad idea.  

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    • Posted

      Thank you for your input Chico. A library of information as always. I have decided to struggle through the weekend and try to get a doctors appointment on Monday. I don't want to make the wrong decision. I'm busy icing every 2 hours trying to numb the pain. I could addin the odd ibruprofen but have a hernia and take lansoprazole for reflux associated with it, the pharmacist said ibruprofen would aggravate it.

      its certainly a minfield this knee replacement club. Trying to stay positive when in pain is the worst thing. But, I am a determined lady!

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    • Posted

      I had lived with a hiatal hernia since I was 14...popped tums and Rolaids for the reflux all my life.  Used every drug as they came out.  At 62, found out that the acid was starting to cause Barrett's Disease in my esophagus...pre-cursor to cancer.  So I had my friendly general surgeon take care of it once and for all...simple op.  No more reflux...Barrett's symptoms gone.  I suggest you do the same.

      Yeah...have the doc review your meds and maybe make some changes.  Once you're 2-3 months, post-op, all that really bad pain will be gone and you won't need those meds.  However, it's important to be as pain free as possible early on.  Nothing but a coma will take all the pain away, but you should find a way to make it tolerable.  Taking your mind off of it is a big help...

      https://patient.info/forums/discuss/the-power-of-rest-some-great-strategies-to-try-on-a-tkr-617892

      Be well... 

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