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