Shoreline

Hey MPD, Like Aranger mentioned it's normally done for pump trials or a new product called Depodur is available for post op pain. This product will give you more than the normal 4-6 hours of relief from epidural morphine injections. It may be interesting how he bills it as far as treatment code because he's either using it hopefully to stop a huge falir and the pain cycle or your leading towards a pump if you get excellent relief.
You can google Depodur and read more about it but this is a longer acting version of the preservative free injections they do for a pump trial. Pump trials can either be done into the intrathecal space where morphine would be most potent or into the epidural space which doesn't require puncturing the dura or a catheter but isn't quite as potent. The newer formulation will give longer lasting relief but it's not a recognized use as a treatment method for the management of chronic pain, meanng It's an option to reduce a flair but not a weekly option that would most likely cause scarring over time.

The big advanatage of epidural or intrathecal morphine is placing an opiate where you have exponentially more opiate receptors than anywhere else in your body and the newer long acting version can give you relief for several days. Do be carefull with your normal dose of meds while the morphine is working. You will have a much clearer head than an equal amount of oral or IV morphine because epidural and intrathecal meds don't run through your entire body. Epi drugs will migrate through the dura into the intrathecal space where pump meds are delivered.So an epi injection is just as telling as an IT injection as far as a pump trial without the risk of nicking the dura.

MY concern would be lack of comunication and not being aware if he's leaning towards a pump trial without first discussig the option. If you have a positive result from the injection it would make sense to go ahead with a pump, but the trust me and don't ask questions level of communication is far beyond the blind trust I would give any doc. The advantage for the doc is not having to write more scripts, avoiding the DEA spot light and not worring about rapid growing tolerance with OxyC in particular.

I knew the product so it was easy to google and find more info about it's use. In your case it would be an off label use, or a variation of a pump trial. The doc may ask you to discontinue you oxy for 48 hours after the injection which shouldn't be a problem if your given an equianlegesic dose of epi morphine.

DepoDur® is the 1 dose decision for epidural management
of pain following major surgery. DepoDur's DepoFoam®
technology is designed to reduce peak morphine plasma
concentration and extend release for up to 48 hours.
1
Previously, extended-duration delivery of an analgesic
could only be provided with continuous infusion of
morphine through an indwelling epidural catheter.
2
DepoDur® is indicated for epidural administration, at the lumbar level, for the treatment of pain following major surgery
DepoDur® is administered prior to surgery or after clamping the umbilical cord during elective cesarean section
DepoDur® is not intended for intrathecal, intravenous, or intramuscular administration
Administration of DepoDur® into the thoracic epidural space or higher has not been evaluated and therefore is not recommended

DepoDur® is a Schedule II controlled substance and is subject to abuse and diversion.

DepoFoam® is a registered trademark of SkyePharma.


Good luck and let us know how it goes. Dave