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Anesthesia

Limno
Posts: 24
Joined: Feb 2015

I met with my anesthesiologist today.  He asked if I would I would like epidural or a spinal anesthesia to control pain along with general anesthesia or general anesthesia alone.  I asked him what he thought was best.  He said he had reviewed my recent CT scans and would go with a spinal over an epidural (with general anesthesia) because of spinal degeneration related to age and arthritis.  Is there any drawbacks with choosing a spinal along with general anesthesia?

APny's picture
APny
Posts: 1947
Joined: Mar 2014

Does the anesthesiologist feel that it's needed to control pain? I only had general and then a self-administered morphene pump afterwards. I was able to get up and walk that same evening which is important for recovery. I don't know if I'd like anything injected into my spine and don't think it would have made a huge difference. After 24 hours (maybe even less) they discontinued the morphine and I was just given pain killer pills every four hours. Unless the pain is believed to be really dramatic I would probably pass on the spinal. But that's just me.

Footstomper's picture
Footstomper
Posts: 1238
Joined: Dec 2014

In such cases I would always follow the advice of the medics. Theyve probably done it far more often than you (unless you've had a disastrously interesting life).

Limno
Posts: 24
Joined: Feb 2015

Before this event it has been my good fortune to only go to a hospital as a visitor.  I am inclined to follow the experts advice but will look into the rational a little further.  I have a degenerative spine so the anesthesiologist indicated it could be difficult positioning the needle.  Yikes, so when I asked if he thought it was neccessary he said it was a really good idea to control the pain.

Limno
Posts: 24
Joined: Feb 2015

Thanks for your response, sounds like I could forgo the spinal and be able to control the pain on my own terms.  I wasn't aware that a spinal or epidural were an option and wondered if this was usual part of the procedure and was presented for the sake of transparancy.   What caught my attention was he was bringing this forward to control the pain.  I wondered if the pain was so severe that I needed this to overcome what I was about to experience?  Having never had surgery, my mind began to run amok.

APny's picture
APny
Posts: 1947
Joined: Mar 2014

Limno, same here. Never been to the hospital except as visitor. Aside from a broken ankle and a torn meniscus, I never had anything remotely resembling pain. So I was also terrified that it was going to be horribly painful. It really wasn't. I had an open partial but my incision is small. So that may make a difference; where the tumor is and how large the incision has to be. But for me neither a spinal nor an epidural was offered and really, I don't think I needed it. As I said, I was up and walking that same night. Not very well, and a bit shaky, but walking. Ask the surgeon how large the incision will be and then go from there if you and the anesthesiologist (and your surgeon) think that additional control for pain may be needed.

Jojo61's picture
Jojo61
Posts: 1310
Joined: Oct 2013

I agree with Amy....the pain was not that bad. There is discomfort, of course, but the pain killers should do the trick. (morphine doesn't do anything for me....I knew that from a prior surgery, but didn't mention it). It wasn't til the next night that they gave me dilaudid instead, and I went "ahhhhhhh" as it quickly took affect. So the first 24 hours, I really didn't have much for pain killers. Your call, though.

Good luck!

Hugs

Jojo 

Footstomper's picture
Footstomper
Posts: 1238
Joined: Dec 2014

I agree with Jojo, pain was never really an issue and they have lots of excellent ways of dealing with any discomfort you might have. Morphine does work for me. I had a great nurse when I was in hospital who had just returned from military service in Afghanistan.  He said to me, "How is your pain on a scale of 1 to 10, and if you say more than five I can give you morphine." 

 

 

6

 

Dont fret it

foroughsh's picture
foroughsh
Posts: 775
Joined: Oct 2014

I was on morphine for almost 12 hours and then it was up to me to use painkillers, I had severe shoulder and back pain right after the surgery so I used painkillers few times but not much.

APny's picture
APny
Posts: 1947
Joined: Mar 2014

May be a silly question but if you get an epidural or spinal block, can you get up and walk later that day? I think it's really important to get you up and moving as soon as possible and I'm not sure if you can with those. Something to ask the anesthesiologist. I've no idea how they work.

Limno
Posts: 24
Joined: Feb 2015

The anesthesiologist said the spinal block would be effective for pain control during and immediatly after the operation.  The admissions nurse said the day of surgery I would be bed ridden and out of it.  However the next day one of the ward nurses would  get me out of bed and walking.  The spinal will produce less negative side effects than general anesthesia alone and should allow me to come around faster after surgery.

JoanneNH
Posts: 115
Joined: Sep 2013

Yes, you can get up and walk with an epidural.  I had one and it didn't affect my legs at all, just had a numb abdominal region.

APny's picture
APny
Posts: 1947
Joined: Mar 2014

Joanne, thanks. Good to know. Limno, that's interesting. I was not out of it or bedridden on the day of the surgery. Surgery in the morning and they kicked me out of bed that evening. But really, you must go wtih what you and your doctors feel is best.

a_oaklee
Posts: 440
Joined: Nov 2013

Of course it's always good to ask the anesthesiologist for all the pros and cons.  My husband had a long surgery, open nephrectomy under general anesthesia.  He was also sitting in a chair for a short time that evening.  He was given a pump where he could give himself pain meds into his IV.  His pain was controlled.  Your anesthesiologist told you that if he does a spinal with a general you wake up easier.  This is true, and it is because you are given a lighter general.  I would not want a light general.  Who cares if you are sleepy.  If you are not a smoker and are not terribly overweight it doesn't matter if you are sleepy.  The most common side effect I have seen from spinal sis a spinal headache.  They are pretty severe.  The procedure of getting a spinal or an epidural is a bit of discomfort momentarily.  Not a big deal, and I don't think it should be part of the decision process.

Limno
Posts: 24
Joined: Feb 2015

I guess the end result is the same even if the path is different.  I am surprised at being presented with choices and find myself listening carfully and going with what the medic feels to be the most advantageous. My aim now is to get out of bed the evening after surgery like APny and Mr Oaklee. When all is said and done I will tell you how everything went, but surgery is still over 4 weeks away.

brea588's picture
brea588
Posts: 240
Joined: Jul 2012

I guess it could depend on the type of surgery also.  When I had the Robotic Laprascopin partial Neph, my Urologist Oncologist would not let you out of the bed the day of surgery due to increased chance of bleeding from the surgical site in the kidney.  I dont know but maybe if they take the whole kidney out that risk is not there and you can get up or my doc was extra careful LOL  I had morphine through pump and that controlled my pain.  I took just a few pain pills after I got home.  Best of luck to you.  Praying for you

APny's picture
APny
Posts: 1947
Joined: Mar 2014

Mine was partial also but open, not lap. Maybe risk of bleeding is different for lap surgery but they kicked me out of bed that night. Sloan Kettering was really like bootcamp: they had me walking an insane amount, lol. But I really think it helped in a quicker recovery.

donna_lee's picture
donna_lee
Posts: 900
Joined: Feb 2009

but you need to ask your own questions and get authoritative responses.  What are the benefits and drawbacks of both?  How extensive to they anticipate your surgery to be?  How many specialists will be involved?  Do they anticipate having to remove bits and pieces to biopsy rapidly while you are still on the OR table?  Has there already been mets; or do they have to search for and remove possible nodal involvement?

With an epidural and other happy shot injections fed thru lines, I was under in the OR for 11 1/2 hours.  The kidney removal was finished in 2 1/2 hours (I was told) but then they had to go after the nodes, the liver mets, biopsy suspected cystic areas of the remaining half of the liver, figure out what was wrong with my gall bladder.

I had warned them that it would be barf city if I had Demerol or "high times" with morphine, and no one wanted me puking with that big incision.

What ever the decision, best wishes and have a happy outcome.

Donna

rae_rae's picture
rae_rae
Posts: 300
Joined: Oct 2010

I had an epidural with my open nephrectomy. I was up and walking with it in, they only numb the abdominal area. I had my epi in for 4 days (in hospital for six) as I had a few surgical complications. By day four, I was ready for it to come out as it became very uncomfortable. The pros, no pain meds to make me constipated (that happened at home, on vicodin) and fairly good pain control, though in my case, not complete. Cons:  As my incision was in the front, under the diaphram and then to the left, they couldn't numb too high or risk me not being able to breathe, so I still had a lot of upper abdominal pain. I also had full wits about me, so I wasn't feel loopy at all. Not sure if that was a good thing or not :)

 

Limno
Posts: 24
Joined: Feb 2015

I had the surgery on April 24, so I am in recovery for two weeks.  Like most, the worst part of this experience (outside of the diagnosis) was the waiting for surgery.  I had the sense that if I could just get through the operation I would be fine.  But I did have a nagging concern about pain.  Pain seemed to be the biggest drawback to a partial open nephrectomy versus a laproscopic total nephrectomy, my only two options.  The Anesthesiologist, opted for a spinal block with general anesthesia for the procedure.  Post surgery, there was no pain around the surgical site or incission.  I had a morphine pump in recovery and over my 5 day stay in hospital, didn't need it once.  I felt discomfort from lying in bed for hours at a time but no real pain. So I feel very lucky, I don't know if it was the spinal block but that was one thing I didn't have to worry about.

I did commit to start walking the day of surgery and I felt that I could but was told to rest because of unusual blood loss during the surgery.  I was up and shuffling around the next day.

The worse part of the recovery is rib pain in my upper chest on the opposite side of the surgery. After a couple of hours in bed, if I move my right arm or turn over I get a sharp pain under my right breast. The surgeon said that during surgery there is a bar that comes up on that side of the table so they can move your body around to the optimum position.  I haven't been unable to get a full 8 hours in bed since I returned home and end up getting up in the middle of the night and sleeping in my recliner.  The pain has diminished over time only lasts for a few seconds but is irritating.

The second worse part is lack of energy. It is getting better every day but if you push too far then I feel really tired, its like pulling an all nighter at University.

Once again thank you to everyone for your kind words and consideration.  You made a scary time much less so.

Jojo61's picture
Jojo61
Posts: 1310
Joined: Oct 2013

Glad you are home and the surgery is all behind you! You are right - the worst part of the surgery is the waiting! The spinal block sounds pretty cool. Now don't rush things.Listen to your body.And take care of yourself!

Hugs

Jojo

 

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