Epidural pump for a few days

[Pooka1]

Aussiemum, I want to congratulate you on that wonderful blog! I found that extremely interesting.

A while back I had mentioned that I read a testimonial on spinekids about an epidural being in place for a few days for one child. That was doubted by someone on this forum I think.

But I see your daughter had one. I am hoping that my daughter's surgeon will be using one also. Her operation is on 26 March 2008.

Thanks again for that blog.

sharon

[txmarinemom]

A while back I had mentioned that I read a testimonial on spinekids about an epidural being in place for a few days for one child. That was doubted by someone on this forum I think.

Since I'm the only only I see who "doubted" the "testimonial" (no source was cited in your original post) to which you referred in any way, I'll assume you're talking about me, Sharon. My EXACT statement was:

"I'm not sure where you read this, but epidurals aren't at all normal after fusion surgery. For one thing, it would preclude getting the patient up and walking (they had me up the next morning after my fusion) - and that IS the goal. Walking greatly facilitates recovery: I can't imagine them using one at all, much less leaving it in."

Del would have to confirm this, but I'm *guessing* Elysia had an epidural because she had five (count 'em, kids ... FIVE) ribs removed.

I stick to my stance that "normal" fusion surgeries do not warrant epidurals.

You'll soon have your own base of knowledge vs. the expertise gleaned from "testimonials" you read or anything I write. Best to you.

Pam

[Aussiemum]

Your welcome Sharon!
I had put this up for interstate and overseas relo's but had wished at the time of elysia's surgery that there was more of these available. So glad to share.

Regarding the Epidural - We weren't even told about this prior to the day by our surgeon. It seems there job is to correct the curvature. Pain management for us was totally handled by the Anethetist. He told us that he was going to place one on her and that it may or may not work! We were lucky that it did.

Our friends daughter, surgery, thoracic scoliosis 1 week later - different state, did not have an epidural. Also the boy next to Elysia on the same day as her had spinal lumbar surgery (not due to Scoliosis) did not have an epidural.

Maybe Pam's correct that it was due to her having the 5 rib's removed. I won't know anything until we see the surgeon on the 31st.

As for getting out of bed, we were told in ICU that Dr Cree likes his patients to have 48 hours of bed rest. So Surgery was Tuesday and and Epidural turned off Friday morning. She sat on bed Friday morning and then Catheter (sp?) out later that day and so had to get up and walk to toilet - no problems.

I don't know what kind of epidural it was, that's if there is different kinds, but I know she could still move her legs.

Glad you enjoyed the blog - the bear is very applicable isn't it!

Del
xx

[Pooka1]

Your welcome Sharon!
I had put this up for interstate and overseas relo's but had wished at the time of elysia's surgery that there was more of these available. So glad to share.

One thing I love about the blog is that our daughters are very similar in terms of type of curve, degree, age, Risser, etc. I hope S has as great an outcome as your daughter did.

Regarding the Epidural - We weren't even told about this prior to the day by our surgeon. It seems there job is to correct the curvature. Pain management for us was totally handled by the Anethetist. He told us that he was going to place one on her and that it may or may not work! We were lucky that it did.

Our friends daughter, surgery, thoracic scoliosis 1 week later - different state, did not have an epidural. Also the boy next to Elysia on the same day as her had spinal lumbar surgery (not due to Scoliosis) did not have an epidural.

Maybe Pam's correct that it was due to her having the 5 rib's removed. I won't know anything until we see the surgeon on the 31st.

I hope you post about that.

As for getting out of bed, we were told in ICU that Dr Cree likes his patients to have 48 hours of bed rest. So Surgery was Tuesday and and Epidural turned off Friday morning. She sat on bed Friday morning and then Catheter (sp?) out later that day and so had to get up and walk to toilet - no problems.

I don't know what kind of epidural it was, that's if there is different kinds, but I know she could still move her legs.

I think I've heard about "walking epidurals." Maybe she had that?

Glad you enjoyed the blog - the bear is very applicable isn't it!

Yes it is! I hope my daughter reads the blog. You did a great job with that. Can't say enough.

Best regards,

sharon

(text added so post will post)

[Singer]

Great blog, Del! It's simply amazing to me how fast kids recover -- and with 5 ribs out, no less!! Best wishes to you and Elysia.

[Susie*Bee]

Yes, Del-- that is a wonderful blog. What an ordeal, but you both (and family) came through with flying colors! Elysia is quite the success story-- and you are quite the "Mum"!!! You have a beautiful family. Thanks for sharing!

[txmarinemom]

Del - Great blog (the "Poo Poem" cracked me up - LOL!) and gorgeous girls!

Pooka - whether Elysia she had a "walking epidural" or not, she was on bed rest for 2 days. I believe Del wrote they removed the epidural (and catheter) before she was ambulatory (even before she was allowed to sit up on Friday).

Unless there are mitigating circumstances or complications, doctors in the States don't typically "do" 2 days of bedrest.

As I believe I've said before, the had me up walking the next morning after surgery; they do the same with most kids who have "normal" procedures (removal of 5 ribs is *not* standard).

Hopefully your daughter gets that epidural you're sure is so common. I've never read of anyone of this board (except Elysia) who had one, and no one *without exception* if you narrow it down to the States and a standard fusion.

Out of curiousity (and because I still have tons of free time - and bouts of insomnia ;-), I ran a deep search on posts here, and couldn't find one *single* reference to an epidural after fusion (not related to pregnancy).

Even if I *do* have loads of free time, I can think of at least 1000 ways I'd rather spend it than debate on this ;-), and certainly have no desire to play the "That was doubted by someone on this forum I think." game. I truly hope everything goes as you expect, and she has an uneventful surgery and speedy recovery.

If your daughter's surgery is set for March 26th, she should have her Anesthesiology pre-op soon (if she hasn't already). If she's had her pre-op, her doctor should have reviewed the surgical plan with you.

Instead of "hoping her surgeon will be using one also", why not simply ask and nail down the details?

Regards,
Pam

[LindaRacine]

Hi...

I think some surgeons routinely do post operative epidurals. I'm not sure why it's not routine, but I suspect it's because there are significant risks.

Here are just a few of many references on the subject:

http://www.ucsfhealth.org/adult/medi...ineCenter.html

The patient will be evaluated by the anesthesiologist, who will discuss managing pain both during and after the operation. A general anesthetic is required for spinal fusion. An epidural catheter, a thin flexible tube, may be inserted in the back at the conclusion of the operation to help control pain.

http://www.blackwell-synergy.com/doi...ournalCode=pan

http://www.anesthesia-analgesia.org/.../98/4/956/TBL3

Regards,
Linda

[mariaf]

I think some surgeons routinely do post operative epidurals. I'm not sure why it's not routine, but I suspect it's because there are significant risks.

Wow, Linda - if that's true I'm surprised to hear it - I guess because out of all the people I've spoken to about their/their child's fusion nobody has ever mentioned it. Very interesting - I am looking forward to reading the articles. And I agree, the epidurals are probably not used routinely because there are risks and downsides which I guess most surgeons feel outweigh the benefits.

Thanks for the information!

[Pooka1]

Hi...

I think some surgeons routinely do post operative epidurals. I'm not sure why it's not routine, but I suspect it's because there are significant risks.

Here are just a few of many references on the subject:

http://www.ucsfhealth.org/adult/medi...ineCenter.html

The patient will be evaluated by the anesthesiologist, who will discuss managing pain both during and after the operation. A general anesthetic is required for spinal fusion. An epidural catheter, a thin flexible tube, may be inserted in the back at the conclusion of the operation to help control pain.

http://www.blackwell-synergy.com/doi...ournalCode=pan

http://www.anesthesia-analgesia.org/.../98/4/956/TBL3

Regards,
Linda

Wow those was great references, Linda.

It seems like epidurals for posterior spinal fusion in children are safe and effective. And they appear to be routine at some hospitals.

I'm sending these links to my surgeon and asking if my daughter can get an epidural. And if not, why not.

Thanks again.

sharon

[txmarinemom]

Pooka, again, I hope you get what you want, and your daughter will be an exception to standard practice.

Only one of those links Linda posted was to an actual facility - the other 2 were studies, and both were conducted by Dr. Tobias (who is apparently a big advocate, and is listed in a large percentage of studies on the topic).

I never said PCEA (patient controlled epidural) was *never* used - or didn't exist: I said it isn't common (at all). Finding a site for one facility (UCSF) that routinely uses PCEA, doesn't make it routine.

Blackwell Synergy has another, more recent study out there (by doctors other than Tobias) who concluded epidural is no more effective than IV, although prevailing opinion is PCEA (patient controlled epidural) *does* have advantages over PCA. Their findings:

Conclusions: By evaluating morphine sulfate usage between groups, the analgesic effectiveness of continuous thoracic epidural analgesia bupivacaine and fentanyl doses used revealed no significant improvement over intravenous morphine sulfate analgesia alone in patients after posterior spinal fusion surgery.

Regardless, existence - or efficacy - was never the issue. The issue was frequency of use/availability.

There's a SRS study out there (it's from 2001 - last updated 6/2005, but without really digging, I found nothing any more recent that's so exact) where they polled surgeons on their use of PCEA. While surgeons may or may not believe PCEA is effective, the study found:

CONCLUSIONS:
Epidural analgesia for post-operative pain control in spinal fusion for adolescent idiopathic scoliosis is safe and effective. A large number of spine specialists do not utilize epidural analgesia for post-operative pain control, despite numerous reports in the literature-documenting efficacy, safety, and earlier return of bowel function when compared to PCA. The technique we describe allows insertion of the epidural catheter tip without difficulty, and permits advancement of the catheter in the epidural space more than 10cm from the point of insertion. The efficacy reported at our center with no catheter complications, may be a direct result of this newly described technique.

Despite efficacy, there are risks, and who knows if that influences common use. A 2002 SRS study found:

Conclusions: Although both CEA and PCA provide effective pain control following surgery for AIS, patients with CEA had significantly better pain scores for all time periods, less fluctuations in pain and lower maximum pain levels during the postoperative period. However, close vigilance is required with patients treated with CEA since adverse effects are common and may required temporary discontinuation to avoid permanent injury.

The only way you'll know is to ask your daughter's surgeon. You didn't answer whether she'd already had her pre-op (surely so for a March 26th surgery date), and normally they discuss post-op pain management. I'm genuinely curious to hear his answer.

I do know the two big SRS surgeons here in Houston, Marco and Hanson, who do almost *all* of the scoli surgery at Shriners don't use them on routine fusions. I'll email him later and see if he'll elaborate why.

I just got off the phone with my friend James (an anesthesiologist here in town) to get his view from that side. He was hard pressed to provide a firm answer on why it's rarely used, but he had a couple of educated theories:

1.) Most surgeons *want* post fusion patients to feel at least a small bit of pain; otherwise complications have the potential to go unnoticed.

2.) Many surgeons in the States - and some anesthesiologists - don't yet see the technique as proven, and of course it's difficult to find parents who'll agree to a non-widely used technique.

He said the topic often comes up in journals, but (and he's been a doctor for nearly 20 years) he's yet to see it in practical application - and only knows a few colleagues who have.

It would be interesting if PCEA is more effective, and doctors choose to avoid it - but I can't imagine they'd avoid it without reason. The answers should be interesting.

Pam

[mariaf]

1.) Most surgeons *want* post fusion patients to feel at least a small bit of pain; otherwise complications have the potential to go unnoticed.

Pam,

That thought actually crossed my mind as well.

I would imagine if the patient didn't feel ANY pain they could do damage either with their movements or, as your friend said, because a problem could potentially go unnoticed.

It's an intesting topic though for sure. I'm going to ask Dr. Betz about it as well. I know that post-fusion epidurals are not routine at Shriners Philadelphia but I'd still be interested to see if he would ever consider using them in certain cases or what his thoughts are.

[Aussiemum]

Hmmm - I certainly opened a can of worms on this one! Let me just tell the details of Elysia's epidural.

Firstly she STILL HAD PAIN! When she was in ICU they had to move her down to x-rays and every bump hurt! When they rolled her onto the x-ray table it hurt! She could still move her arms and legs and they came and checked this ALL the time.

It was just as soon as she didn't have to be moved and was settled again - her pain quickly went back to a level 1 or 2. They were ALWAYS asking her what her pain levels were and as she also had a PCU pump with morphine obviously they knew the epidural wasn't going to hold off all pain and she did press this and use it without anyone telling her to, so there was obviously some degree of pain.

There was something obviously unusual about Elysia's case and why they were using the epidural (as Pam said before, maybe the 5 ribs??) - I didn't think to ask at the time because I just thought it was standard practice. I will ask and find out on the 31st though. She was an exception as even the ICU people were suprised at how little pain she had compared to the many other cases that come through.

Hope I can answer this one after our appointment
Cheers
Del

[sanah]

I had an epidural pump in my back for a couple days. They took it out on thursday I think, and my operation was monday. It could have been wednesday though, XD the middle of the week kind of ran together in my mind.

[Aussiemum]

Hi Sanah,

Are you in the USA or elsewhere?? Just curious as they don't seem to use the epidural in the states or much here in Australia either.

Hope you feeling goooodddd!!!!

Del
xx