Epidural Question

[Eeyore346]

I met with the anesthesiologist yesterday. He said he is recommending an epidural in addition to regular anesthesia. I have never had one. I have a couple questions and you all have been so wonderful with my other questions I thought I'd come to you for answers.

1. Did any of you have one with your surgery? Comments about it?

2. I thought it was just a shot in your back. My friend who is a nurse said they put a line in your back and can keep adding more medicine. Anyone know the truth? Truthfully I have seen shows on TV about giving birth and it seemed to me they just got a quick shot.

Thank you,
Sandy

 

[westexas]

Hey Sandy,

Had 4 of them....4 C-Sections.... It is not an easy process. Kind of like a spinal and you have to lean over to have them insert the needle......As long as you have nothing wrong with your back, I here it is great. They keep it in for several days and from what I understand, you feel no pain. That is a good thing....With the c-sections, I did o.k. but I have scoliosis of the spine and it worked 3 out of 4 times. Josephine can enlighten you on that and I would be curious too as to the usage of the epidural....

Hey, loved you coming over to the hip/knee forum....Not too many of us and I am giving Ref a hard time....

Keep us posted....Patty

 

[JudyS]

Hey Eyeore,
I had one in the past for childbirth.
But to help even more I had one on June 6th as part of my anesthesia for my THR.
I wanted to go into the operating room totaly awake as I wanted to look at my doc's tool box (that's how he referred to it)
Normally the anesthesiologist gives you something to relax you, which leaves me with no memory after that point (in the waiting room)
Well I looked around at as much as I could. The nurse held me in a sitting position bent forward as far as I could go. When the anesthesiologist came in and started cleaning and draping my back I thought "Oh no, this is going to hurt"
Then he told me he was giving me something to relax me and I felt no different..stilll scared, then the nurse found the kink in the IV line just as he injected the needle, it hurt like crazy for an instant and that is all I remembered,.

He had told me he was giving me an epidural so he could give me less of the general anesthesia and woould inject more morphine in it after surgery. The total was supposed to last 12 hours. I also woke up with the PCA in place. Nobody took anything out of my back after I was aware.
I do believe they can be a one time injection or an actual something left in place to inject more.
Judy

 

[kittykat]

epidurals can be used in different ways. the one-shot deal (usually used in childbirth) consist of a local anesthetic (like novocaine) being injected into the space around the spinal cord which causes everything which is ennervated below the level of the injection to go numb. it also disallows you from walking because you have no muscular control!

another way epidurals can be used is the same as above, but with a pain pump attached (the same kind they give IV) after the operation, and so they can leave it in for ~12-24 hrs and you can give yourself pain relief through that access. the downside is they can't take your foley (tube in the bladder) out until they discontinue the epidural, and you can't walk! this is a downside because usually after THR they like you to be up and walking that night (if it was a morning operation) or the next day (if surgery was later in the day), and with an epidural that may be delayed until you get feeling in/control of your legs again.

it's a choice, and if it's being offered to you as an option I would recommend discussing it with anesthesia when they clear you pre-operatively. they can give you all the pros and cons, tell you what to expect in more detail, etc.

best of luck! I am 3 weeks out and walking unassisted with almost no pain! I will post on this in the next day or two just to share my experience.

kittykat

 

[sunshine]

I had this with my hip surgery and was attached to pain meds for two days. I think they wanted to use this on me because I am allergic to so many pain meds and were afraid I would get sick and also told me it was less complications possibly. I just laid on the table sideways when they inserted it, I don't remember anything but him touching my back and I was gone.
I did feel great when I woke up, not groggy like some operations I have had. I did get a terrible headache for two days after but ice applied to head I was fine.

 

[JudyS]

Kittykat,
I will be 2 weeks tomorrow and have a hard time putting all my weight on my operated side.
I know everyone is different but I can't imagine walking unassisted next week. Are you taking pain meds? After about 3 hours I start feeling pain, by 4 it is pretty evident.
Have I asked you before what your position in the medical field is?
Glad you are doing so well
Judy

 

[Josephine]

epidurals can be used in different ways. the one-shot deal (usually used in childbirth) consist of a local anesthetic (like novocaine) being injected into the space around the spinal cord which causes everything which is ennervated below the level of the injection to go numb. it also disallows you from walking because you have no muscular control!

another way epidurals can be used is the same as above, but with a pain pump attached (the same kind they give IV) after the operation, and so they can leave it in for ~12-24 hrs and you can give yourself pain relief through that access. the downside is they can't take your foley (tube in the bladder) out until they discontinue the epidural, and you can't walk! this is a downside because usually after THR they like you to be up and walking that night (if it was a morning operation) or the next day (if surgery was later in the day), and with an epidural that may be delayed until you get feeling in/control of your legs again.

it's a choice, and if it's being offered to you as an option I would recommend discussing it with anesthesia when they clear you pre-operatively. they can give you all the pros and cons, tell you what to expect in more detail, etc.

best of luck! I am 3 weeks out and walking unassisted with almost no pain! I will post on this in the next day or two just to share my experience.

kittykat

Words right out of my mouth! Still, saved me a long post ....

In the UK we very often give a spinal AND a general anaesthetic. Helps to allow a lighter GA.

Kittykat,
I will be 2 weeks tomorrow and have a hard time putting all my weight on my operated side.
I know everyone is different but I can't imagine walking unassisted next week. Are you taking pain meds? After about 3 hours I start feeling pain, by 4 it is pretty evident.
Have I asked you before what your position in the medical field is?
Glad you are doing so well
Judy

To get the maximum benefit, you need to take meds before the pain breaks through, whilst you are just suffering from discomfort. That way the meds have less to get on top of. If you leave it until you are IN pain, then the meds will take much longer to get effective and maybe not work so well at all. I have this neat chart here to show what I mean

 

[kittykat]

Kittykat,
I will be 2 weeks tomorrow and have a hard time putting all my weight on my operated side.
I know everyone is different but I can't imagine walking unassisted next week. Are you taking pain meds? After about 3 hours I start feeling pain, by 4 it is pretty evident.
Have I asked you before what your position in the medical field is?
Glad you are doing so well
Judy

I am taking pain meds, still quite a lot, actually, but I started with a tolerance so that's part of the reason my pain med level is higher. today I kind of overdid my activity and so am quite sore tonight :o I need to be careful!

I haven't stated what I do in medicine just b/c I don't want to put myself in a position of giving medical advice here on this forum, but I can comment on most meds and procedures with some confidence

what josephine said about staying on top of the pain is true, but I am finding that if I take the meds every 3 hrs, which is kind of how often I need them, I am going to go too high on my acetaminophen. I no longer get any painmeds that are just pure pain med without the APAP -- so I kind of have to spread the pain meds out more, thus NOT staying on top of the pain...at Least if I overdo it.

so I guess the take-home message for me is "DON'T OVERDO IT!!!".

any suggestions, josephine? I'm still on an anticoagulant (I will be until next week), so can't take NSAIDs yet. I guess ice is always good, and rest, and the PT exercises.

 

[JudyS]

Kittykat,
No problem with the med situation , I understand totally.

I have been going 6 or 7 hours in between meds at some times. I know everyone here and pretty much all nurses tell you to keep up with them.
Last summer I had cervical fusion surgery. I was taking vicodin every 4 hours (2 at a time) The first time I went for a post op apt. I remember telling the nursse I was taking 6 tabs per day.
My OS said "6" that is a lot, and 2 is not better than 1.

My 2 week apt is tomorrow aft. and I am wondering if I will get the same response .
I do take 2 at a time. I was on vicodin before surgery so I could remain very active.
I don't know what to expect
Judy

 

[bnew]

Well, my nurses aren't telling me to keep up with them. (I guess that could be because I'm 4 1/2 weeks post op, but still...) I feel like I have gotten the third degree every time I've had to call for more pain meds. They just gave me lortab this time; said I could not have percocet anymore. I don't know why, I was only taking two pills right at bedtime! Are they really afraid of people becoming addicted? Or are there other reasons why?
Bridget

 

[kittykat]

Well, my nurses aren't telling me to keep up with them. (I guess that could be because I'm 4 1/2 weeks post op, but still...) I feel like I have gotten the third degree every time I've had to call for more pain meds. They just gave me lortab this time; said I could not have percocet anymore. I don't know why, I was only taking two pills right at bedtime! Are they really afraid of people becoming addicted? Or are there other reasons why?
Bridget

I know. I find it very humiliating to be treated with suspicion when I need pain meds. however, the reason my OS asked me to come in early (3 weeks instead of 6 weeks) is b/c of the frequency with which I was asking for pain meds. he said he wanted to see me to make sure everything was ok (get an xray, check for infection, etc) since I still need lots of pain meds, but I think he wanted to eyeball me and make sure I'm not looking like a crack wh*re (yeah, 3 weeks out from a THR!!). anyway, I just told him flat out (which I've told them all along), "I have a tolerance. if I take less than this right now I won't get pain relief". he said, "that's all I wanted to know, that's the conversation I wanted to have". he said he will be happy to continue managing my pain, and we agreed that I will taper off the oxycontin for now and stay on the percocet. BUT HE'S SO STINGY!!! he gives me 30 at a time, that's like a 3-4 day supply! I asked him if he could give me a larger amount and he said no, they like to "keep track" of what pt's are taking. so it's frustrating, but I guess I should just be glad he SAYS he'll manage my pain. I guess we'll see if he really means it....

I know mt GP will prescribe for me if he cuts me off, so at least I have back-up. I don't like asking all the time.

what I was going to say, though, is I'm glad he asked me to come in at 3 weeks because he upgraded me SIGNIFICANTLY in terms of allowed activities, so I re-gained a lot of freedom. my PT had been saying she thought I could upgrade for the past week, and she was frustrated that my OS is so rigid about the 6 week plan and 6 week F/U visit b/c she felt I had progressed so rapidly and could do more, and that going in the pool would be beneficial, etc. so it is a good thing my OS wanted to 'check me out' I guess...

 

[JudyS]

Kttykat,

I too must have some type of issue with pain meds as if I take 1 percocet or 1 vicodin it does not seem to have any effect on me. The first time I used vicodin was last summer after cervical fusion surgery so I have not built up a tolerance. My surgeon then told me 2 was not better than 1 and I needed to cut back. so I did and just lived with the discomfort. (pain)

When I was first going through endocrine testing, it was determined that I rapidly metabolize dexamethazone. So I assume it is the same with other drugs which may be the reason for the need for 2 percocet.

I will share that with my OS today and see what happens. If I continue to take percocet at night that is 8 tabs per day.
The pain study doc sent me home with 20 tabs!!!!! When I called my OS he prescribed 75. I will seee what happens today.
Judy

 

[kittykat]

I sympathize. I take 10 percocet/day now with pretty incomplete pain relief (and this is the max of acetominophen that is safe), and he only writes for 30 at a time. I have to call every 3-4 days!! what do you bet he's going to soon (again) be saying -- "didn't I just write you a prescription??".

...yet when I saw him for a 3 week check a few days ago he assured me that managing my pain is of paramount importance to him. what a chooch!

we'll get through this, but I wish they would be a bit more realistic about their patient's pain issues.

 

[Stanj]

The limited number of tablets per prescription might be an insurance company mandate, either yours or his malpractice insurance. A friend from Dallas who recently moved here after closing his practice in the US was describing the restrictions on his practice placed by insurance companies, quite often a clerk who can override a doctor's decision, made every choice of procedure or medication a battle unless it was on a short list of approved actions. Everything else needed permission and phone calls to the insurance company. Your doctor might be operating under the limit of not being able to prescribe more than what you are getting.
A patient becoming habituated to pain medication is a likely risk of a law suit.

 

[JudyS]

Kittykat,
I saw my OS yesterday for a 2 week check-up. Everything looks great. He wants me to still use crutches or a cane for 4 weeks until I see him again.
As his nurse was walking me to the exam room she asked if I needed more pain meds. I said yes.
When the doc came in , after he asked me if I wanted to shoot him!!!! He asked if I still needed to take 2 percocet every 4 hours and wrote me a prescripton for 100 more.
I had told him I could only put more weight on my operated leg if I was in the window where percocet was really at its strongest!!!

My spine surgeon and he work together in the same practice (the one who wanted me to cut down immediately last summer)
As he spine surgeon got to know me more, he said I was more like him (very active to get away from crazy society) very reluctant to take pain meds and very unlikely to become addicted. I'm sure this info was passed on.

Anyway, I hope you continue to have luck getting pain relief. Sorry you have to be a frequent visitor to the pharmacy.
Judy