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Old 12-31-2010, 11:42 AM   #1
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Fusion surgery!!! PCA pump meds?

I am having a spinal fusion in Jan and at my wits end with the chronic pain.. I have been on Oxycodone and Hydrocodone for about 2 yrs now.. I am opiate tolerant as the docs call it.. When I meet with the anestigiologist in a week or so I will be asked to choose my pain med options post-op recovery room and the PCA pump while in the private room.. I have taken morphine and dilaudid IV for pain in the ER and while in the hospital.. The question I have is the rate of the Dilaudid given my weight would be 2.0 mg initial dose, 1mg per hour locked to 8 min intervals and not 2 exceed 6mg in a 4hr period.. Morphine would basically be 10x those figures based on the potency difference.. Being that i require more medication than most because of my use of opiods is these accurate doses? I assumed they may be a little higher.. Im just concerned the pain releif will not be effective at these doses.. Has anyone had a surgery and been on similar dosing or what were the doses some of u have had using PCA with these 2 meds.. Dilaudid seems to work better but Id like some feed back.. Thank You!!!!!!!!!!!

 
Old 12-31-2010, 01:45 PM   #2
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Re: Fusion surgery!!! PCA pump meds?

frustrated: I don't remember exactly, but.... I had dilaudid after a cervical fusion last year. I am also opiate tolerant. I THINK I got 2-4 mgs in recovery and then .1mg every 10 minutes if I pressed the button. That would be .6 per hour. I'm probably smaller than you, though. So I think yours might be accurate. I had the pump too, I could press it every 10 minutes, and I pretty much took advantage of that. It worked amazing. When I was moving from the recovery room, the recovery nurse made a comment that "my doctor was very generous." I was incredibly worried about post-op pain, as I had had a prior fusion and I was left in intense pain for about 12 hours after the surgery and the nurses wouldn't give me anything more than 1 5mg percocet (after I had been taking 10 mg every 4 hours pre-op). I made sure that I talked to my doctor in the pre-op area and when the pre-op nurse asked me if there was anything I needed to get straightened out before surgery, I told her that I wanted to know what my post-op pain med plan was. They did a good job taking care of me and I was very grateful.

However, the woman next to me had a different surgeon and she was crying all night after her surgery because she was in pain. I felt bad for her but me and my dilaudid were doing just fine...

I would always choose dilaudid over morphine for IV.

 
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Old 01-02-2011, 09:33 AM   #3
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Re: Fusion surgery!!! PCA pump meds?

while i cannot quote you actual doasages, i AM opiate tolerant(been on OC at 70-70-60 since 05,and been ON it since 03) and have had to have six surgeries and an aneurysm coiling too, all since? i would go with dilaudid hands down in the old PCA. and usually they will just go with the morphine while in the post op recovery since it 'hits' a bit better for the more acute pain post op just is and they usually will dose MS according to your pain level and tolerance too if you are lying there dying, ya know what i mean? they HAVE gone out of the norm/standard boundries for me in the recovery room before..

the one thing i would speak with the anesthesiologist about is OPTIONS. have a plan A at one particular dose and if that does not feel effective enough, you set up a bit more a as just 'possible' and there for you if needed. this is what my wonderful ortho who simply DOES understand my screwed up body, and insane pain sysdromes and other syndromes you get from SCI can just do to pain? he always has three plans in place for me since we DID have an 'issue' with who i call 'stupid nurse". thats a whole nother nightmare. but after that, he now calls up to the floor i will be going to and speaks directly with the head nurse and tells her 'our" three plans for my possible pain and spasticity reactions that can make it worse.

its just ALWAYS a good thing to have the 'back up plans' with the possible raising of dosasges, or the loick out if things don't feel covered enough? its really great that you are actually meeting with your expected anesthesiologist at all there well before your actual surgery. i did not see mine til the day OF, but had already discussed my pain stuff with my ortho previously and again right before my surgeries with him.

but dilaudid really has always worked the very best for me in the PCA, despite being on what i have been on for so long. also see about getting a med called vistiril(sp?) it has kind of a muscle relaxant properties along with this ability to also just help the narcotic work much more effectively on post op pain too. the combo is a good one i have used a few times. just a thought for ya to ask the anes about. good luck with the surgery hon, Marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 01-02-2011, 02:33 PM   #4
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Re: Fusion surgery!!! PCA pump meds?

I think they also gave me toradol (sp?). It's not a narcotic - they called it a "pain med and muscle relaxer." I also got this IM the two horrible times I had to go to the ER. I think it helped.

I think my recovery room plan was 1mg dilaudid every 2 or 3 minutes until I "stabilized." I got about 5 IV pushes before I got to a 6 and then they sent me on my way. They were LONG minutes, but I was only in 9 or 10 pain for about 10 minutes and then after that I was set.

The other thing is that they disconnected my PCA the following morning about 10am. I had had my surgery at about noon the day before and I WOULD NOT disconnect so soon if I had to do it again. I was feeling so great, I was like "sure, you can disconnect" plus I was tired of dragging it the bathroom with me. I started PT right away in the morning. The first visit I dragged my pole with me, but then I did it without and it slowed me way down. If I have to have another fusion, I would probably ask for another 6-9 hours on the PCA, even if the dose was lowered. It's just such an effective pain management tool. I wish sometimes I had it at home!

GOOD LUCK. Let us know how you did. Don't overdo it either. If you are having a lumbar surgery, no twisting or bending, they mean it.

 
Old 01-08-2011, 03:50 PM   #5
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Re: Fusion surgery!!! PCA pump meds?

I recently had a L45 fusion, I did not get the choices you got, I just got what they gave me, oxycontin and oxycodone. I do know that excessive use of both can cause serious breathing issues. I am 48 days out, still have lot of back pain from the surgery and top of thigh pain which I think is from imflamation. I have been walking from the first day, but still sleep half time and take my drugs. I didn't get a pain pump for this last surgery. Keep your chin up. You'll be okay.

 
Old 01-08-2011, 03:52 PM   #6
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Smile Re: Fusion surgery!!! PCA pump meds?

Quote:
Originally Posted by Roy Faverty View Post
I recently had a L45 fusion, I did not get the choices you got, I just got what they gave me, oxycontin and oxycodone. I do know that excessive use of both can cause serious breathing issues. I am 48 days out, still have lot of back pain from the surgery and top of thigh pain which I think is from imflamation. I have been walking from the first day, but still sleep half time and take my drugs. I didn't get a pain pump for this last surgery. Keep your chin up. You'll be okay.

 
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