Re: : 2 wk post-op visit with surgeon/preop pain relief

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In a message dated 10/14/01 11:49:47 AM, duodenalswitch

writes:

<< I also asked why the epidural wasn't just placed during the

surgery, and Dr. M said that the chances of having it correctly

placed are vastly improved if it is done under flouroscopy. Too bad

they don't have flouroscopy in the OR, then I could have had the

whole business done under anesthetic, although the doctors probably

don't like have an increase in the amount of time spent under

anesthetic. In my case, I think it would have been better. I really

don't tolerate pain well, do I?

>>

Dang - I thought they did flouroscopy-guided epidurals there.. at least

that's what Joe Frost said when he got his. I worried about this as well. I

had an epidural with my first birth and suffered horribly with the insertion.

I told the anesthesiologist to just forget it with my second after about 20

minutes or more of poking... Now, I realize the epi for surgery is different

from that for pregnancy, but I think I would have faced a similar problem.

For anyone who is considering an epidural for the DS: ASK about flouroscopy.

I did at Mt sinai when I was investigating this possibility and they said it

would have to be done in the flouroscopy room FIRST, then after it's inserted

go to the OR. In other words, the floroscopy room would have to be reserved,

etc. beforehand and add at least another hour to the entire process! It

would have been worth it, though b/c I knew that I had experienced tremendous

difficulties with insertion before...

This is not to scare anyone or state that everyone would encounter this

problem -- I do think that most people don't have problems with epidural

insertion. I just knew beforehand that I was one of those lucky few who do!

I decided to go with the morphine pump since I had the DS laparoscopically

and really didn't have anyproblems with it. But, I did fully investigate all

pain relief options and discussed them with my surgeon beforehand. Dr.

Gagner/Mt. Sinai has the preferred pain relief of morphine/demerol pump and

they administer numbing meds at the site during surgery. He also immediately

provides another drug - I can't remember the name - shucks! - as an

anti-inflammatory in conjunction with the narcotic pain relief... Other

surgeons may prefer an epi. However, just because a surgeon has a preferred

method doesn't mean that you will not be able to choose a different form of

pain relief that you think suits you better. Dr. Gagner said he was open to

an epidural although he greatly preferred the pump and thought that would be

sufficient.

So, my advice to pre-ops is: Research all options available, the good/bad of

each method (epis carry a risk, although slight, of spinal headaches and

spinal leak/drip which would require a 'patch'; morphine/demerol drips may

need to be adjusted and it could take awhile to find a correct level of pain

relief, etc.). Ask what the hospital policy is on the epidural - you may

have to get special instructions to reserve flouroscopy room, etc. before

surgery and DEMANd it if the hospital normally does 'blind insertion'. :)

All the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

almost 9 months post-op and still feelin' fabu!

preop: 307 lbs/bmi 45

now: 213 (?)