Worried about managing restless legs around surgery? It’s a common problem for people with RLS.

managing restless legs around surgeryFor people with restless legs syndrome (RLS), having surgery can be a challenging experience. Not only can RLS symptoms get worse around surgery, they may not be able to control their medications as they are too unwell, sedated, or because they are kept and dispensed by nurses whilst in hospital. Understanding these challenges and planning ahead can help with managing restless legs around surgery.

Why can RLS symptoms get worse around surgery?

There are a number of factors that can contribute to RLS symptoms getting worse around surgery:

  • Some types of medications used as part of the anaesthetic or for post-operative pain control can worsen RLS symptoms
  • People can be immobilised after surgery, particularly after leg surgery or major abdominal surgery, so not able to get up and move around to relieve RLS symptoms
  • Blood loss from surgery, common with joint replacements, can cause iron levels to drop and worsen RLS symptoms
  • There may be an interruption to the normal dose and / or timing of RLS medications because people are unable to take medications orally or have medications controlled by nursing and medical staff who may not understand the usual medication regime

It’s important to control RLS symptoms, not just because they can be very distressing, but if legs are constantly moving they can interfere with wound healing or increase the risk of post-operative bleeding, particularly with leg, knee, hip or major abdominal surgery.

Here are some tips to help manage your RLS symptoms

  • Plan ahead by meeting with your RLS physician to work out your medication needs
  • Communicate with all the healthcare providers on your surgical team at every stage of your treatment
    • you may need to repeat information several times to ensure every care provider understands your needs
  • Advocate for yourself and if possible bring a friend or family member who understands your RLS and it’s treatment who can work directly with staff members to familiarise them with your needs in managing RLS when you are not able to such as immediately after surgery

Planning for your surgery

Restless legs planWell in advance of your surgery, schedule time to talk with your RLS physician to review your treatment. Discuss strategies for coping with RLS symptoms during and after the operation, and how you will communicate this information to the surgical, anaesthetic, recovery room and ward teams as well as other hospital staff involved in your care.

It may help to create a written document to present that outlines your needs, including:

  • A list of all of your current medications, including both maintenance drugs and those taken as needed
  • Clearly indicate the timing of each of your medications – either time of day, or number of hours before expected symptoms
  • A description of your WED/RLS symptoms and your needs related to movement
  • The name and contact details of your RLS physician

Before the day of surgery

AnaesthesicIt is important that you discuss your RLS medication with your surgeon and the anaesthetic team. This will allow the anaesthetist to plan ahead of time any modifications to the anaesthetic and post-operative medications that are needed. It also allows the surgical team to adjust their usual hospital booking to accommodate your RLS needs, whether that is longer in hospital because of changes to post-operative medication, or earlier discharge to allow early mobilisation after surgery.

RLS medications should be taken for as long as possible before an operation, up to the time you are directed to begin fasting before surgery. This is important not only for controlling your WED/RLS symptoms, but also for minimizing any side effects related to re-establishing the dose after your surgery. The night before your surgery, take your usual medications unless otherwise directed by your doctor.

Prepare the following to take with you to your surgery:

  • At least one day’s supply of your prescribed RLS medications in case the pharmacy cannot get medications and be sure to let your nurse know that you have these medications with you
  • The document outlining your needs that you have prepared with your RLS physician. Bring several copies to give to different teams, such as the anaesthetic team and the nursing team on the ward where you are looked after following surgery. Plan to keep one copy with you at all times, and ask your accompanying family member or friend to share with healthcare providers when you are unable to do so

On the day of surgery

When you meet with the anesthesiology team, discuss the potential problem of RLS symptoms appearing during surgery, if done under local anaesthetic, or worsening RLS symptoms after surgery. This is a particular risk with medications that are sometimes used in anaesthesia or for post-operative pain relief.

Medications to avoid:

  • Antiemetic agents with dopamine antagonist or histamine antagonist properties (metoclopramide, prochlorperazine and promethazine)
  • Opioid antagonists (naloxone, naltrexone)
  • Antihistamines that cross the blood-brain barrier (diphenhydramine in particular)
  • Tricyclic, tetracyclic or selective serotonin re-uptake inhibiting antidepressants (If you are already on these medications, they need to be continued)
  • Neuroleptic agents (including droperidol and phenothiazines)

It’s also important to let surgery and anaesthetic staff know that unless you are under general anesthesia, your missed RLS medication may trigger the need to move and/or involuntary leg movements. Should this occur, a narcotic can be used, as narcotics (opiates) are helpful medications in managing RLS symptoms.

After surgery

post op restless legs syndromeThe early period after surgery is a high risk time for restless legs symptoms, as often people are not able to take medications orally and they may be nursed in areas such as recovery room or high dependency units not familiar with their usual routine. During this period, opiate or narcotic medications that are often used for pain relief can be a helpful treatment for RLS symptoms. There has also been some research on using rotigotine (Neupro), a dopamine agonist administered via a patch during and after surgery. As soon as possible you should restart your RLS medications, but this won’t be until you are able to take medications orally which can be some days after abdominal surgery. In some instances you may need higher doses of RLS medications than normal because of immobilisation after surgery, or lowered iron levels from blood loss in surgery.

People with RLS know that timing of medications is important in best managing symptoms. This can be an issue in hospitals where you may be taken off the ward for tests such as x-rays or therapy, or if nurses do drug rounds at fixed times. Ensuring your healthcare team understands the importance of taking medication at the required time is one of the keys to managing RLS symptoms after surgery.

While surgery presents special challenges for people who have RLS, you can take steps to minimize difficulties and ensure the best possible experience.

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