Discussions that mention morphine

Pain Management board

Hi Dave....I have a question for you, and for anyone else that is familiar with morphine given through an epidural or IC pump. I'm going to be pre-medicated with Morphine through the epidural before surgery. Morphine has never helped me pain wise, whether it's oral, IV, or IM. But, from what I understand, when it's given in the spine, it's very potent. The pre-op Morphine will be given to help me post-op, in addition to everything else. I was just curious of how you would rate the epi Morphine. Any feedback is greatly appreciated! Take care and bye for now. :)
Hey Keystone, Any med given epidurally r intrathecally is going to be much more potent because you have exponentially more opiate receptors in your spine than any where else in the body. However if they can undermedicate epidurally just as they can undermedicated any other route. If you don't respond particlaurly well to morphine it simply may not be the right med for you. The good thing is they wil get some exposure to your tolerance. If they expect you to be pretty medicated by say .5 mg every hour for the pro2-3 hours prior to surgery, they will have chance to recognize just how tolerant or inecefctive you are to morphine. They can use an y preservative free med like dilauid or fent. I hate oral dialudid, it has a short half life and is nowhere near as effctive as IV dilaudid which worked for every surgery. I would remind them of your past experience and they will have expectations from th dose they give, if they have enoough time to cratch their chin an wonder why your ntot properly premedicated, hopefully the doc will make the proper adjustment in dose or change to another med.

Just to give you an ida of th e potency of oral compared to the pump. I took 600 mgs of Kadian or MSC a day to equal what 12 mg a day deliveed by pump That would be alot if your tolerance isn't in that area, and some docs have drugs tthey prefer, but dialudid isn't a strange request iof you respond better. It's not like it's know for a better high or has a bad reputation in the anesthesia arena. It does have a a notorious rep in th e IV abuser comunity, bu the two are hardly the same.

I think the best thing you have going for you is some time for them to see no drowsiness, no drop in pulse or BP and anxiety building. Normal measurable signs that would show them meds are taking effect.Definitely discuss having proper doseing instructions or parameters on order because it takes longer to get an anesthesioogist to actually come and do a pump eval and adjustment than it would for a surgeon to make an adjustment by phone order with an oral, IM or IV med.

Be sure you remind them how long you have been on meds, what you use fot BT and ask them to not reverse anesthesia with an opiate antagonist, It's much better to take an extra hour in recovery to wake than it it too have anesthesia reversed. If you ahve a truted friend or SI that's going to be here, with your tolerance to qtiq, I would want my wife ther with some in her purse. As big a no no it is to bring meds to the hopital, if you have someone there with you, an you know your tolerance is high, You want to be prepared. Please be careful and if not for the invasiveness of the sugery, I wouldn't have mentiond it, but you don't want to be in the position that you gave to much trust to a surgeon or anesthesilogist you are not familiar with. If you don't have someone that can stay with you and monitor your response ro medicationn, It's very risky especially if you find you need to supplementing afer surgery.
Good luck, Davve
Hi Dave..thanks for the reply! My PM doc is meeting me in Pre-op holding in the morning. He said yesterday at my follow up appt. that I would need around 10mg epi Morphine, with all the fentanyl I'm on. He will also be giving the parameters for pain meds to the anesthesiologist in the morning when we meet him. He is going to try to find out today who is assigned to my case, so they can already start talking. He also told me to bring my patches (they will need to be changed while I'm in the hospital...he said bring them just in case the "forget" to change them. The last thing he wants, and I want, is to be in w/d. I will also bring some Actiq, his request as well. I figured with the 10mg epi Morphine, that says I'm pretty darn tolerant. LOL

My family (parents and husband) will also be with me. I'm scared as hell, but, with my last surgery, my PM doc wasn't on staff at the hospital. I changed docs over a year ago, and this one IS on staff if there are any problems/concerns. It does help with the anxiety knowing my PM doc will be meeting me and the anesthesiologist in Pre-op to go over everything. I wish my PM doc still did OR anesthesia, but he doesn't. I already brought up the reversal and it will be brought up again in the morning, in writing and orally so there is no confusion. They will also be able to "see" my patches on my chest. So, hopefully, there is no oversight. I will post again before I leave in the morning. Thanks again. Bye for now. :)