Re: Pain Management during surgery

[Guest guest]

I had a total pancreatectomy in 2003. I had a team of pain management

doctors on call that visited me frequently (several times a day). I

opted for an epidural on advice of the surgeon. Before I went into the

OR they placed it. I could tell I didn't have good coverage but the

pain doc said " don't worry, if it isn't good enough we got you

covered. " And they did. It did not help much and by the time I woke up

in the SICU and they got me extubated I screaming and rolling around

in severe pain. The pain docs rushed in, hooked up a PCA, left the

epidural in, and bolused me both epidural meds and dilaudid. They got

it under control, but I had problems for months with severe pain. A

perfect epidural should eliminate most of the pain. But I had a less

than pefect one. If I had it to do over again (heh I wouldn't have the

surgery) I would have started with the PCA. What is important is that

you know you got a pain management team that will be there for you.

That makes all the difference.

Good luck! I second guess myself and wish that I would have tried a

whipple first.

Happy Autumnal Equinox!

Bert

> What did you use for pain management, epidural or IV? How did it

> work for you? I am nervous about the epidural, because I've heard

> they fall out and you can't feel your legs, etc. I want to make

> sure I get the best pain management for my upcoming Whipple.

[Guest guest]

Hi ,

The surgery that you are undergoing is a major abdominal

procedure. The anesthesia that will most likely be used will be

the type that there is basically no chance that you will wake or

feel pain of any kind They will use a very, very deep general

anesthesia....the type when you are basically on life support (for

breathing that is, because it paralyzes your muscles). I have had

two major abdominal surgeries and half a dozen less drastic

procedures and from my experiences, the likelihood of you

waking up or even feeling pain is basically not there. Now

coming out of GA is another story, as well as the recovery period

for the next few days and weeks. Usually what will happen is that

they will give you a PCA pump (for patient controlled anesthesia)

and it will have morphine or dilaudid or some other powerful

pain med. It is a lock-out type machine that allows you, the

patient, to directly control when you get a dose of med. It is set so

that you can not ovredose yourself....it has a lock-out mechanism

so you can only give a dose once every ten minutes. It is an IV

system. Then as you get better, they will try to get you to take

pain meds by mouth. Usually this is done the day or so before

you go home, and can be one indicator of your readiness to be

discharged.

So basically, in a case of this kind of surgery. you do not have to

worry about feeling pain during the procedure itself....it is virtually

impossible with the type of anesthesia that is used. Your body's

mechanism for feeling pain just isn't functioning at that time. It is

in the recovery unit and the ward that your pain, if any, will

become apparent. This is the time period when you have to

advocate for yourself for proper pain management. But most

hospitals are very good at post-surgical pain control

Of all the things to be apprehensive about with your surgery, this

is the least thing to worry about, in my experience.

laurie

[Guest guest]

Hi there,

Of course the surgery itself will put you under as deep as you can go.

They will use two different meds to control paralysis and anesthesia.

You will be entubated. They will have an aterial line to monitor your

vitals up to the second. You will have a central line put in once you

go under so they can push heavy volumes if need be.

But it does indeed matter what kind of pain management you get when

you wake up. Because as soon as you are entubated if you are not

adequately covered you will know it. Like I said an epidural alone was

not enough for me. PCA helped a lot. They actually also gave me

morphine in the central line while being on both the epidural and the

pca. My pca had dilaudid I received almost 2 mgs. an hour! So find out

about the kind of pain management teams they have and talk to them

before hand if possible.

Bert

> Of all the things to be apprehensive about with your surgery, this

> is the least thing to worry about, in my experience.