Epidural vs. PCA experiences

[kiik]

For those who have had bowel surgery, did you have an epidural or a patient-controlled pain pump through IV (PCA?) What was your experience like? For those who only had PCA, was your pain still manageable?

(I'm asking for myself because I'm having surgery in just over a week, but also because I thought this thread would be helpful for others having to make this choice!)

 

[GutlessWonder86]

hi kilk,

i'm going in for surgery again myself in 2 weeks. I prefer the PCA pump because then I am able to sit up in bed or a chair without pain and then go for a walk in the hall. The more you walk and are able to keep down your food, the sooner you can go home.

With the epidural, you are not able to feel your legs and are partially paralyzed for a while. My friend had that and she told me it took a while before she could get up and walk.

I'm not happy about what I have to go through again so that's my game plan: PCA pump, sitting up once the anesthesia wears off, eating what I can tolerate, and walking. I hate the hospital my surgeon's at but I have no choice so I plan to go in and kick butt.

FYI: you have that right to refuse a resident (doctor in training who needs x number of patients to practice on before he can go into private or a group practice). The attending on call is a real MD who oversees the residents. You can request him only to examine you and the Real Nurses.

Seeing as it's June, the 4th-6th year residents are graduating and the new 1st years don't start until July. (I learned that from working in the Ob dept.at a local hospital). It's best to have surgeries from Sept. - June if you can otherwise you are the 1st yr. residents victim, I mean patients from July - beginning of Sept. and they have to get their feet wet.

I always tell my surgeon I refuse to have a resident cut me open UNLESS he's in the top 5% of his class, a 5-6th year,listens to his patients (I judge him if he listens to my questions/concerns & gives me an honest answer. NO BS allowed), and works with my surgeon in coming up with a game plan. I've seen too much since I was 12 and have learned that a patient has rights which include asking questions.

hang in there and have a speedy recovery!!

 

[DustyKat]

I don't know that epidurals are done that often with routine surgeries in Australia??

Both of my children had open resections and had PCA's post op. I can't speak for them but as an observer they certainly appeared to work well both immediately post op and in the days that followed. Neither ever complained that the pain wasn't controlled and the anaesthetist always kept a close eye on things.

Good luck with your surgery!

Dusty. xxx

 

[kiik]

Thanks to both of you! With the PCA, how would you (or how would your kids) describe the pain level? I'm just scared it will be way to much to handle for me! Although I think I have a pretty high pain tolerance after years of Crohns..

 

[GutlessWonder86]

if you are still in pain, just call the RN and ask if she can contact your surgeon for something else to get you more comfortable. Nowadays, there is a pain level poster in the room and they focus more on keeping the patient comfortable while recovering.

 

[DustyKat]

As GW has said, if the PCA doesn't hold the pain you can always ask to see the doctor.

For both of my kids that wasn't necessary. The anaesthetist comes at least daily and checks the pump, it is computerised, and will assess how are you doing based on how many times you have pressed the button over a given time period and also with the feedback you give. They were always encouraged to press the button when they needed too and were advised not to leave the pain and bear with it. The button was able to be pressed every 5 minutes.

And now I have just remembered I did a wiki article on PCA. :lol: Here is the link:

http://www.crohnsforum.com/wiki/Patient-Controlled-Analgesia-PCA

Dusty. xxx

 

[Absentminded]

I also had a PCA after both my surgeries. I refused an epidural, even though it was recommended by the hospital, as I've had a few friends who have had bad experiences with them. I only had the PCA for two days and then managed on tramadol and then paracetamol. By the time I left hospital after my open resection a week later I was only taking a small amount of paracetamol.
I hope everything goes well

 

[Trish22]

Epidural s do not work for me,they have tried it a few times and it has never worked,tbh I am worried about my surgery on Thursday,as the pain with just the PCA on my last two ops was really unbearable,they certainly did not get my pain control right when I opened my eyes after the surgery,I remember showing myself up in the ward,as the pain was unbearable,I could not speak as my mouth was so dry,I could not explain that I needed my mouth moistened,and the sweat was pouring out of me,and no one had thought to put a fan on,they did say that they now have pain management teams,wel. I ope they address this this time,because after the last time I vowed I would never go through it again ,but that was 11 years ago and really hope things have moved on and got better.

 

[evescott]

I opted for the PCA route when I had my proctocolectomy. There was still pain but it was definitely manageable in my opinion as long as I was realistic with the things I was attempting to do. After seeing the list of complications with an epidural compared to the one possible nausea side effect of the PCA, I was decided pretty much straight away despite my mum's warning tones!

PCA definitely worked for me and I was off it within a few days to everyone's surprise and onto fentanyl patches and oral painkillers.

I hope all goes well!

 

[Trish22]

Thanks for that Evescott,I keep telling myself things will be better this time round,especially after really stressing to my surgeon the pain I had, I have not yet met the aneathatist but will also emphasise on my past problems,When I was first offered epidural with my daughters birth C section they administered the epidural,checked with pin pricks down my chest and the aneathatist told the surgeon to proceed with caution,even though I told him I felt some sensation,When they put the scalpel down my Pre crohns scar (going into same scar)OMG the pain,they had to stop,has the epidural had not worked,I was so truamaised and went into a total shock,that will live with me for always,
So when I woke up with the pain from the crohns,I was told it was because of the severe adhesions I had,whether or not this is right I don't know.
I think I will be ok,they tend to listen to patients more today than what they used too.

trish x

 

[acc929]

Hi! I have had both, PCA quite recently so I'll give my two cents: epidurals are awful. I had one for my resection when I was 14. Not only did it basically not stay in (told the nurses I felt wetness on my back but no one turned me over, turns out it was leaking) but it caused more problems than it solved and the PCA was most often sufficient. With an epidural, what everyone says is true: you're in bed longer, and walking is essential to getting you up and out of hospital. It also makes it nearly impossible to pee for quite a while after it comes out, but you can *feel* that you need to pee, which is an awful experience. The same might happen on a PCA depending on the painkiller (I had dilaudid both times) and your sensitivity to it. I was allowed to press my button every seven minutes. Make sure if you're lucid enough post-op that they haven't put a *limit* on your PCA because this is a major issue especially post-op, where they told me in PAC-U that I couldn't go up to my room until I was off their IV whatever and on my PCA. Turns out there was a 4mg in 4 hour limit and mine starting beeping at me pretty soon after I got to my room. The biggest problem with the PCA is when you try to sleep. Depending on how you feel, if you're not pressing the button frequently because you're sleeping, you'll wake up in major pain. IMPORTANT: You can ask your nurse for a "bolus dose" before you go to bed that should tide you over longer (and held you sleep, though that's not really a problem with a PCA ). My biggest recommendation would be to get off the PCA and onto oral painkillers as soon as possible. Oral painkillers give longer, stronger relief. IV painkillers are fast-acting but quick to leave your system.

Best of luck! xx

 

[Traumanurse]

I had both last week for my surgery. Wasn't totally happy with the epidural because every time I gave myself a dose, I dropped my blood pressure. Took days to get that regulated. Also it felt like a vice around the bottom of my chest and I couldn't take big deep breaths. All in all, a PCA was best for me

 

[xSophiexx]

I had PCA morphine.. lady on same ward had epidural. I have been out of bed walking round had a bm etc whilst she is still sitting in chair with epidural cant move hasn't had a bm. Everyone is different but it seems as I was able to move it sped things up. Also im a baby and found pain bearable with PCA

 

[rob101]

After having open surgery I was given an epidural that didn't work it only numbed my legs instead of my torso . They then gave me ketamine to settle the pain before putting me on a Morphine pump that I could self administer . If I had the choice again I would definatelynot go for the epidural !.

 

[Ang71]

Dusty Kat
I'm in Australia QLD and go for surgery next week I have been offered a epidural they put it higher up so only ur stomach is numb also been offered a plane (tab) block that numbs the nerves in ur abdomen also the morphine pump!

 

[Ang71]

Kiki
My last two surgery's I had the morphine pump it made me drowsy and nausea. I go for my third surgery next week and would like to try something different. I have read the epidural is really good better than the pump. i can't find to much info on the plane (tap) block that also has been offered to me so I'm thinking the epidural. I went on the colon clubs web site and did some research there. Coloncancersupport.colonclub.com
Hope all goes well

 

[DJW]

I've had both on numerous occasions. Both worked well. The epidural made me very itchy all over. Gave my benadril (sp?) but it didn't help much.

 

[valleysangel92]

I had a PCA. I found it ok as long as you remember to keep pressing the button all the time, for me it seemed to wear off pretty quickly and made me feel sickly but it was the first time I'd had morphine so that may of been part of the problem. It was pretty easy to move around with the PCA (despite a huge IV stand) and I was allowed to take oral paracetamol as well if i wanted.
On the most part managed my pain enough but it caused a huge problem when my IV had to be taken out and wasnt replaced for hours because the nurse on the ward wasnt allowed to do it. Had to wait for my surgeon to come see me and ask one of his juniors to do it.
I know my sister has had the PCA a few times for both open and laproscopic surgery with no problems and loves them.