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Thread: Pre Surgery Pain Management Consults

  1. #1
    Join Date
    May 2016
    Posts
    48

    Pre Surgery Pain Management Consults

    Hey All, I had a life changing experience after waking up from lumbar fusion surgery back in 1998. I was screaming in pain, and it took the acute pain management people over 30 minutes to stabalize me. There is no doubt from post op problems that there had to have been nerve damage during the surgery, but that is not why I am posting. I am considering the complete scoliosis/kyphosis correction surgery, from the base of my neck to the sacrum. I know there will be a lot of pain when I wake up. I contacted the hospital, and asked if I could consult with the acute PM team, so they would know my history, extraordinary tolerance to pain meds, etc... I met a lot of resistance, and was told they don't see patients until the morning of the procedure. That is not good enough for me. I was told they take the current dose of opiates you are using at the time of surgery, add a bit more, and wake you up. Then, they "assess your pain level and adjust appropriately". I asked if I got an appointment with the out patient PM program, whether they would coordinate with the acute PM people so as to have a game plan in place well before the surgery. I was told they don't have anything to do with each other(!) I won't go through what happened in 1998, but no person should ever have to endure that amount of pain. So, I am asking folks who have had the procedure how their preparations went. Did you meet with the PM team that would be taking care of you right after surgery well beforehand, or just on the morning of your surgery? I find it hard to believe the acute and OP PM programs have no contact with each other. I wanted to see the OP PM people anyway, to see if the pain generators caused by my 1998 surgery could be isolated, and thus remedied during the scoliosis procedure. I want this to be my last back surgery, and need all my ducks in a row before I do it. Your experiences with the anasthesia/PM people prior to surgery would be invaluable to me. Thanks In Advance, RJM

  2. #2
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    766
    I didn't meet with pain management but I think you should. I considered it before my last surgery and wanted to but not for the same reason.
    My SPINE team put a morphine block in the spinal cord and I wasn't too uncomfortable for first few days. Ask about it
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

  3. #3
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,527
    Yes, yes, yes! Many Spinal Teams have a dedicated pain management person. Do meet with that person before surgery. Explain your story (not unusual), and listen. Write down everything that is said.....names of drugs intended, when they will be started, HOW TO GET AHOLD OF PM DOC QUICKLY if there is a problem. At UCSF and OHSU, they were on top of the pain right away.

    Most of the time, there is some experimentation on what works best and for how long. It is a fine line as I was over sedated and they were worried that I would stop breathing.

    This surgery will be different....they all are different, so you may need a different combo of drugs.

    I always ask for a long acting medication (sometimes in a patch) as well as a rescue med.

    I highly suggest that you have someone with you in the hospital at all times to help with lots of things, ESP pain management. My friend Ginger's husband had spine surgery at OHSU and while meds seemed to be ordered postop, he woke up, like you in severe pain. She called the nurse, only to discover that the "orders were not in the chart". The nurse said that the Spine Fellow who was supposed to enter the orders had not done so, and was very busy in the ER. To which she emphatically replied, "there has to be someone in this big hospital that can order Jim pain meds!" She asked for the supervisor.... So, you need a strong advocate in the hospital!

    Best of luck! Be proactive!

    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone + prayer

  4. #4
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,555
    My pain management was discussed with my scoliosis surgeon prior to my surgeries....I was kept under in ICU for 4 days, since I was told I wouldnít be able to withstand the pain if they woke my up. I have also chatted with Anesthesiologists before other surgeries, but they keep it light with the medically untrained.

    What they did as far as pain management I have little knowledge of, and suspect that possibly Ketamine was used but I do admit that I didnít feel a thing as far as spine pain is concerned. My scoliosis surgeon communicated through his team.

    Once I was on the ortho wing, they rotated Morphine, Dilaudid, and Lortab through multiple IV sites along with injections. They told me that it was the strongest regiment they had. The injectable Lortab was powerful, I would ask what todays flavor was when they did the rounds. 6 seconds to zero pain which was quick. Each time I was knocked out, it was 70 minutes till I woke up again....(My eyes were glued to the clock, I became a shot beggar)

    I started oral meds at 10 days post when I went home....Oxycodone and Percoset. Weaned at home alone which was painful. The oralís donít compare.....

    1998 was 18 years ago.....One would think that pain management in scoliosis centers has improved since then....

    Hang in there, and let us know how it goes...

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  5. #5
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    766
    I have had revision surgery and did find it wasn't as painful. The morphine block worked so well that in recovery I was asked if I was in pain and I told my throat hurt. They laughed because after such a major surgery, I only complicated of my throat.
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

  6. #6
    Join Date
    Jun 2011
    Location
    Southern CA
    Posts
    2,224
    I have had multiple spine surgeries and my surgeon aways made sure that Pain Management and I talked before my surgery. I was not in much pain as the nurses were on top of my drugs.
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  7. #7
    Join Date
    Mar 2005
    Location
    east coast
    Posts
    359
    I didn't meet with pain management, but did discuss pain management stuff with anesthesia during pre-op. Where I had my surgery, the default for post op patients is for their spine pain management team to do the pain med orders.

    Was in ICU for overnight and when I woke up, I woke up with a PCA pump of dilaudid for break through pain and oxycodone ER for continuous pain management. PCA pump was great because I was in control for the breakthrough pain -- I could get a booster every 20 mins.

    Got taken off the PCA on day.. 2/3. Transitioned to Oxycodone ER 2x a day and dilaudid every 4 hrs if needed.

    I actually had more bowel pain than surgery pain. To this day no one is sure exactly what my bowel issues were, as I had bowel sounds so it wasn't ileus. I think I had a mast cell related reaction from the narcotics in my gut -- when I got home I started taking anti histamines and that cleared the bowel pain up... so...that's my theory.
    30 something y.o.

    2003 - T45, L???
    2005 - T50, L31
    bunch of measurements between...

    2011 - T60, L32
    2013 - T68, L?

    Posterior Fusion Sept 2014 -- T3 - L3
    Post - op curve ~35



  8. #8
    Join Date
    May 2016
    Posts
    48

    Thumbs up To All Responders

    Thanks very much for all the responses, and sharing your stories. The morphine block I don't think was used in 1998. The scoliosis surgeon mentioned my tissues would be coated with an opioid based gel before I was closed up. Is that the "block"? The MD who has seen my suffering for the last 18+ years thought that an induced coma for a day, then a slow awakening, would be the best way to go. One of the responders seems to have had that done. I do have an appt w/ the OP PM folks at the same hospital the surgery will take place. I hope once they hear the enormous amounts of pain meds I can tolerate, it will kick their thinking into a different level. If not an full induced coma, then perhaps "twilight" sedation while awakening, with things like a PCA pump loaded with fentanyl ready to go. At the height of my opiate use, I was using 1 gram of MS CONTIN per day. Ten 100 mg tablets per 24 hours, which I'm not bragging/proud about, I'm simply relating the facts. That amount now would render me unconscious I would think. I tapered down to 16 mg of Dilaudid and 150 mg of MSIR per 24 hours. That is a long way away from 1 gram of MS CONTIN. The downside is the pain is so bad I am basically sedentary, the surgeon insisted I reduce my opiate intake before doing the surgery. He asked for a 50% reduction, I did better than that I think. I have never used Fentanyl, but understand it is the big gun of pain control. I think they knicked a nerve in the 1998 surgery, making my pain so much more severe than if the surgery had gone well. Given the problems I had post op in 98, ( pain in both thighs after lying on my side for > 2 hours, which was not there before the surgery). I used to sleep on my side. After the surgery, I had to go to an adjustable bed and sleep on my back. The incision also took 12 days to stop seeping, after day 9 they rolled me back in and completely redid the stitches. I was never the same after discharge- the scoliosis and kyphosis came on very perniciously after the 98 debacle. I had an exaggerated kyphotic "hump", but managed to do weight training and was a fanatical endurance stationary cyclist. I enjoyed that the most, my resting pulse was down to 44 BPM. I haven't been able to work up a sweat in so long, I need this surgery so I can get off these horrible opiates and get back to cycling. I want my life back- as much as is possible. I'll keep you all updated. Thanks again for the replies. RJM

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