Prednisone and Surgery

I believe the best practice is to allow patients who are steroid dependent to maintain the sort of dose you are on, which is physiologically necessary.  The anaesthetist should be informed in case you need extra because of the stress of the operation and the fact that your adrenal glands own production of cortisol has been suppressed.  I think surgeons are concerned because they think pred hinders healing, but your dose isn't any higher than your own body would be making.  It would be a shame to trigger a flare because of the sudden drop.

But this is only my instinct.  Others will be along with proper knowledge.  Best wishes, hope the surgery goes well.

I was down to 1 but had had more than five years on Pred. by then and the main worry for the surgeon was my resulting high (ish ) BP ( 160/90 something ) anaesthetist was consulted and she said " you'll be fine" which I was but it was an epidural, not GA.  Don't know whether that's significant. I do remember that I healed very quickly.

I don't understand how dropping so close to surgery would have any effect on healing. It took several months on zero before my fragile skin stopped bruising.

Hope all goes well.

When I initially was struck with PMR in 2014, it was following the death of my mom, then my dad, then a fusion surgery on my back. I was doing great after surgery for the first 5 weeks, then WHAM, I was hit with all this unexplained pain and fatigue. To make a long story short, it took 8 mos to get a diagnosis and start treatment for PMR. It took me until last summer to finally get down to 2 mgs prednisone/day. Then I found out I needed a total knee replacement in late October. I was more concerned with the possibility of the surgery causing a flare, considering my history, than I was with the knee replacement itself. After consulting with my rheumatologist and my surgeon, they decided that I would increase my prednisone to 5mg one week prior to surgery, and would have an injection of solu-cortef during surgery since I couldn't take my prednisone the morning of surgery (no food allowed and I have to take it with food). Then I would stay on 5mg one month post-op, then taper back down to 2mg/day. I did fine with surgery, and no flare afterward. Unfortunately, my other arthritic bone-on-bone knee decided to blow up like a cantaloupe in late November, & with all the extra inflammation, my rheumatologist & my suregeon thought I should get that knee replaced as soon as possible, so it was scheduled for Jan. 8. Then I really started getting scared of a flare, with two major surgeries that close together. I hadn't tapered down from the 5mgs yet, so they said I should just stay on it until a month after the second surgery. Again, I had an injection of solu-cortef during surgery. For one week after surgery, I felt amazing, even better than after the first surgery. Then on the 7th day post-op, I woke up feeling like I'd been run over by a truck and my muscles in both thighs were screaming at me and very stiff, plus my range of motion in both of my knees had diminished significantly. I tried to bear with it for a week to see if it would settle down, but it didn't, & I started to feel some upper arm pain. It felt like PMR pain to me, so I increased my prednisone to 7mg for a week, and it didn't really seem to help, so I tried going back down to  6 mg. Dumb me. In hindsight, I didn't increase it enough to knock down the flare.  I thought I should see my rheumatologist to get some guidance to deal with this. Unfortunately, this was the first time he and I have NOT been on the same wavelength. He thought my muscles were just fired up because of the surgery. I asked why it would hit bilaterally equally, if it was from the surgery and not PMR, but he just didn't seem to be hearing me and wanted me to start decreasing my pred, rather than increase it. I had a horrible feeling about this but was going to try and do what he prescribed. The good thing that came out of the appointment was that he referred me for warm water PT (93 degrees F). The warm water helped loosen my muscles so I could do my PT exercises, but as soon as I got out of the water, the stiffness and pain hit again, and I was hobbling around like a 90 yr old. I felt ill & fatigued. There was no way I was decreasing my prednisone, when I knew in my gut, that I was having a flare. My next mistake was starting to increase my prednisone a milligram at a time, trying to get the pain to stop. It got somewhat better at 8mg for a few days, but started to get worse again. Finally, when I was up to 11mg and feeling like I was starting my PMR all over again, I wrote a very detailed summary of my history of major surgery & getting PMR, and what I was going through right now and how it was getting out of control. I had gotten back on the forum and read how counterproductive it is to chase the pain, and asked him if he thought it might help for me to get an injection to get the inflammation under control so I could start tapering again. He was very responsive and told me to come in & I had a Kenalog injection of 60 mg. I felt amazing by the next morning! I communicated that to him by message, so that he would know that it was my PMR. Jumping ahead to right now, I was finally stable enough 2 wks after my injection, that I felt like I could slowly start to decrease my prednisone again. I asked my rheumatologist if he would trust me to do my taper myself as I'm the only one who knows what my body feels like, and he agreed. He even apologized that he and I were not on the same track earlier, and that admitted that he was wrong. I told him that PMR does weird things, and I've been dealing with it for 4 1/2 yrs and I know when I'm flaring, so we're now doing okay and back on good terms. Sorry this was so long, but this was a long, very painful winter, and I'm glad it's over. Just wanted to let you know how I had to deal with the surgeries and the good and bad parts of it. Really wishing I hadn't had to do two total knees within a 3 mo. time period, but life just does those things to you sometimes doesn't it??

I have just had hip surgery and my surgeon wanted me off steroids. In the end we agreed at 5mg. Did you negotiate with your surgeon? Doctors are worried silly about infection, a major concern with hip surgery, and also slow healing from steroids.  Most doctors will go up to about 7.5mg though. I had a spinal block not a general anaesthetic as I was given a choice. 

After having PMR for over a year, I had knee replacement last year on 6 mgs pred which I had been on for six months at least.  I was encouraged to stay at that amount which I did for another six months.  Three months before surgery, my surgeon gave me a steroid shot in the affected knee and my ailing hip.  I feel the pred helped with the expected pain after the operation.

There are several people on the HealthUnlocked forum who have had various surgeries while still on pred and had no problems at all.

I'm always flabbergasted at doctors who want a patient to drop their pred dose rapidly at this stage - it just opens the door to adrenal insufficiency causing trouble when you have no response to offer to the stress of surgery.