PCA or Epidural

Not sure what a PCA is but I had en epidermal and all went wel. I actually found the shoulder pain to be excruciating from the air they pump in for lapo surgery. Make sure you get plenty of hot packs if you experience this if you are having laporscopic surgery.

PCA = patient controlled analgesia

http://en.wikipedia.org/wiki/P...controlled_analgesia

Yes, I am having laparoscopic surgery. Thanks for the hot pack tip.

I had an epidural and it was great, except they type they used on me was not a drip, but a single injection. It was supposed to last 24 hours, but didn't even last 12. I did have an indwelling epidural catheter, but the anesthesiologist was tied up in emergency surgery all night and could not come to give me a booster. I was miserable. They finally got a morphine drip going on me, but by then I was already beyond reach and they could not give me enough morphine because my blood pressure was too low. This was the one and only time I ever cried in front of my doctor.

Epidurals I had for childbirth were great. I don't know why I could not have had a PCA for breakthrough pain along with the epidural.

Jan

It is my understanding that the epidural I am being offered will include a patient controlled button to allow for a boost to the epidural as needed.

I was leaning toward the epidural, but after your post I will have to have a talk with the anesthesiologist more. From what I have read is that epidurals are great unless it doesn't work for you. Sounds like you fell into that category.

I was leaning toward the epidural because I assumed (maybe incorrectly) that it would be less toxic to my liver. The PSC diagnosis is still really new for me, so I don't know that much about it yet.

I've had both. Only had the epidural once, but had a little (or rather large) complication. Ended up with a post-dural puncture which they tried to resolve for about five days unsuccessfully and then a pain management doc had to do a blood patch. Very scary procedure.

Epidurals- if they work - and without complications - are good because it can be less narcotics into your system so your gut wakes up sooner.

I think when I had the epidural I also had a PCA. But once they figured out about the post-dural puncture/headache/etc.. they pulled that pca for the epidural.

If you do have an epidural and are not getting sufficient pain relief.. get pain management doctors involved on consult. They can oftentimes make things happen faster and more succesfully than your surgeon.

good luck with your surgery.

I just had surgery and had an epidural. I woke up from the anethesia and had a pain level of 10 out of 10. But that's me and certainly not what most people experience. They started giving me dilaudid and that worked. I never had the PCA - I'd just push that call button and they'd be right in with more jammin' juice. The relief was immediate, but it would make me a bit nauseous. Not sick enough to tell them to stop the dilaudid of course. But I started asking for Zofran a few minutes before the dilaudid. That worked well.

I think someone once mentioned that they had an epidural right in their incision? Does that make sense? Does anyone know if that's correct?

Wishing you the very, very best on Monday!

kathy

Wow. Thanks for the replies. I really expected to hear good things about the epidurals.

Maybe I'll just stick with the PCA. It seems that it is still the most common way to handle post-operative pain anyway.

The pain relief from an epidural is remarkable, and much more effective than IV opiates, but epidurals are more difficult for the staff to manage, and not all staff are equally qualified or attentive. I loved it when it was working, and not so much when the staff was screwing up. If the unit has a lot of experience with epidurals then that's what I'd pick.

I was told that the anesthesiologist and pain management team would be in charge of pain relief if I chose the epidural.

The surgical team would be in charge of pain relief if I chose the PCA.

As for the nursing staff on the unit, I have no clue.

When i had my j-pouch constructed 17 years ago,the attempt for an epidural failed. I am not sure why that happens but I was in misery for awhile. Another time I had an epidural and my legs would not wake up for hours afterwards. The dr seemed concerned and I started having such big anxiety, thinking i would never walk again!! I have never felt so out of control. I also have PSC and am lucky that I have had no symptoms so far. Are you taking Ursodiol?

I had an epidural and PCA when I had my first pouch surgery and it was GREAT! I had NO pain at all. For take down I think I only had PCA (It's 17 years ago, so I don't remember the second one as much)

Sounds like there is a wide range of experiences with an epidural. You have all given me a lot to think about.

I'll talk with the anesthesiologist tomorrow morning and make my decision.

Thanks again for the responses. I am officially in full "prep" mode, and 5:20am is going to come before I know it.

I was never given the option. I had the morphine drip and IV drugs only. I was so horribly nauseated with both my surgeries from all the meds that I really wish I knew about the epidural option since they worked so wonderfully for me with my kids during childbirth. I'm a bit confused though...with an epidural, you wouldn't be able to walk, right? Isn't it important that you get up and moving after surgery (when you are able of course)? Is the epidural only for the day of surgery and maybe day after? If so, I think I would go that route!

clz, the kind of epidural that is used for colectomy analgesia doesn't disable your legs -- it's really just super effective pain relief for your midsection. I didn't find out I would be having an epidural until an hour before surgery and I said the exact same thing about walking to the anesthesiologist!

I see I'm too late as your surgery was today, but for anyone in the future, I had an epidural with PCA pump during my colectomy and it worked REALLY well. So well that I only had to push the button maybe five or six times, and I asked the basal rate (the continuous drip) to be halved after a day.

That said, be aware if you have an epidural that they work REALLY REALLY well. I was in virtually no pain while I had the epidural so I didn't take any painkillers after it was removed, and eight hours later when the epidural had completely worn off I was in agony. Take some painkillers immediately when the epidural is removed so you can stay ahead of the pain, even if you think there isn't any!

Good luck JJR, hope everything went well today.

I thought I would followup on my decision. I decided to go with the PCA for Step 1. I was told that the epidural may not cover all of my incisions.

I will likely do the epidural for my takedown surgery though.

My surgery was successful, with a few minor hiccups. I was told the surgery would last about 4.5-5.5 hours, but because of my build it turned into an 8.5 hour surgery. I had some vocal cord damage from the intubation. It is slowing healing, but I may still need to have an ENT repair things though.

I had a lot of trouble tolerating the oral pain medications, but after some trial and error we got that resolved.

I will say that this surgery was more difficult than I anticipated. I still don't have a heck of a lot of energy.

-j

Are you having a 2 or 3 step process? I don't think you'll need it for takedown if it's a two step lapro. I was on pain pills by the next day. It also helps the guts wake up if you can move around. I had a two inch incision where my stomach was due to scar tissue but had minimal pain. I am nearly 4 mos out and feeling awesome. It's nice to not be miserable w UC symptoms.

JJR - glad you're home and on the mend. It does take awhile to bounce back. But you'll get there.

kathy