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Dilaudid IV after surgeries...

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Chronic Pain
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Posted 1/19/2015 4:33 AM (GMT 0)
Hi All,

Hoping everyone had a pleasant weekend and found at least something to smile about or feel good about!

I will be having my surgeries on the 27th (colostomy, total hysterectomy, bladder sling), and was told that after surgery they will be giving me dilaudid IV for pain. They will also try to give me as many of my meds as possible thru IV or injection, and I will be unable to take meds orally for a bit to give my lower GI tract some time to rest/repair itself.

Any thoughts/suggestions/advice regarding pain meds post surgery?

All I take now for chronic pain is Tramadol ER 300mg, and Lyrica 100mg, plus Voltaren gel. Narcotics often trigger migraines, but I don't see any other option for the post surgical pain. I will likely be able to get my botox injections for migraines on Tuesday this week (there is a bit of confusion about things because I got an epidural steroid injection in my neck 1 1/2 weeks ago).

Praying you all have a low pain week, which of course we will all take one moment at a time, one step at a time.

Thanks and take care,

Sunny.
Posted 1/19/2015 4:53 AM (GMT 0)
Whenever I have surgeries or I'm inpatient for the millionth time, my pain dr talks to the surgeon or the dr treating me to come up with a plan. I wouldn't be surprised if they gave you a PCA with dilaudid. Hopefully it will keep your pain under control.
Posted 1/19/2015 6:32 AM (GMT 0)
I had a PCA with .02 mg of dilaudid every six minutes, plus bolus when I needed it (which wasn't often, because of the steady serum levels I think). It controlled the pain very well. Prior to that I was on 40 mg of Opana ER, with no BT med. This was for a hysterectomy, kept my ovaries.

They sent me home with 2mg dilaudid every 4 hours for about 5 days. It was shortly after that I went into PM, because I had the hysterectomy to resolve my pelvic pain, and the result was that it increased my pelvic pain.

Good luck, I will be thinking of you!
Posted 1/19/2015 9:46 AM (GMT 0)
Sunny many migraine sufferers are prone to get rebound from narcotics of the regular variety. The only one I can think of that causes the least issues is stadol and generally if you have a good pm option and or surgeon who is well versed in rebound in headache folks they will use stadol post-op surgerical pain issues. The only problem being it is a short use med but likely can be used to cover the first couple days to get you closer to the point where your tramadol can handle it.
Posted 1/21/2015 4:30 PM (GMT 0)
I had a similar surgery - reversal of the colostomy and hysterectomy. I don't think I had a bladder sling, but the surgeon did something.

My surgery was laparoscopic, 2 teams of surgeons. The general surgeon went first, reversing the colostomy.

Dilaudid is my favorite drug for surgical pain. It makes me feel happy. But it's never given in a high enough dose by most surgeons to chronic pain patients. A dose of .2mg is fine for opiate naive patients, but it's like nothing for those who take meds on a regular basis. I was in hospital over the weekend and I gave my med list to the ER doctor, and she told me I'd made a typo when she read my dose of 2mg/2 hrs for severe pain. Ah, well, she's young. Discuss the dose with your surgeon!

Continuing on with IV meds - that stupid PCA set at .2mg is useless if you use opiates regularly. Also, if you aren't with it mentally, you can't remember to push the button. I had one of those shoved into my hand after a major surgery, where I'd had an arterial line for blood pressure, and couldn't feel it and kept dropping it and couldn't find it. The nurses insisted on putting the darn thing in the unfeeling hand (right) even though I complained. Some nurses are better than others. But again discuss how the med will be delivered.

After my complaints, really, you might only need the dilaudid for a day or two. Surgical pain goes away pretty fast in the abdomen.
Posted 1/21/2015 7:41 PM (GMT 0)
Thanks for the responses! Much appreciated!

I know the plan is to use the PCA w/ dilaudid. I do worry that right after surgery, i'll be out of it, forget to push the button and just lie there in pain. But, my mom offered to stay in the hospital w/ me for the first night if I'm really spacey (colorectal surgeon said that would be fine), so she'll remind me to push the button.

Plus, they are going to use one of those balloon/grenade looking things with a line running directly into my incision with some type of pain or numbing medicine for the first 2-3 days they said.

The anesthesiologist agreed right away w/ me about NO epidural…my spinal cord is 6-8 inches longer than normal b/c of the Spina Bifida going undiagnosed for 20 years. He said with my history, he would not suggest letting anyone put in any epidural at all, so that was put in my chart and he said it wouldn't hurt to be very assertive with the anesthesiologist the morning of surgery and tell him absolutely no epidurals allowed. I will not consent to that at all.

Worries about migraines are a bit better. Got botox yesterday, should be working well by surgery, plus they said the time for migraines will really be when i am going off the strong pain meds, so don't worry quite yet. I also worry though about the days i am not allowed to eat, i tend to get migraines when I don't eat or drink enough, w/ stress, and w/ not enough sleep. Hmmm….at least i'll be getting IV fluids!!

I know this is getting long, sorry.

As for the surgeries:
--bladder sling on an already augmented bladder with a stoma
--hysterectomy w/ removal of ovaries, tubes, uterus, cervix, (getting rid of it all I guess)
--colostomy at level of the sigmoid colon, also removing the rectum, (permanent colostomy)

I'm still having issues w/ neck pain, numbness/tingling from neck down to thumb on left side, and the chronic back pain is bugging me more lately (likely tension from stress), I just worry how long post-surgery that stuff will bother me and how much, because the surgery will likely be anywhere from 5-7 hours long, if everything goes well. Long time to not move around!!

Ok, sorry for rambling, the closer it gets to surgery, the more worries i have. guess that's normal though.

Thanks for listening and sharing your thoughts/suggestions with me. It really does mean a lot to me!
Posted 1/23/2015 2:56 AM (GMT 0)
Sunny, it sounds like you and your docs have done their homework. I think one of the most important things about going in to the hospital, for a pain patient, is planning ahead. So many don't and that is when you usually end up suffering without adequate pain control.

As most everyone has said, IV Dilaudid with the PCA should give very good pain control. I am glad your mom will be there to help remind you to push it! Also ask or make sure that you have a bolus, which is an extra dose of meds. The last time I was in, I was on 2mg Dilaudid every 2 hours, but was not aware I was allowed boluses. They can really help.

I am also glad you got the botox so hopefully you can be as comfortable as possible considering LOL! I wish you the best and hope all goes well!!

Melyssa
Posted 1/27/2015 12:51 AM (GMT 0)
Sunny-

Dilaudid has been the best for me after my surgeries. I have less itching with it to.

My mom just had lung surgery and they did the grenade thingy for her thoracotomy incision. She said she basically had 0 pain because of it. Wish they had that when I had my thoracotomy.


Take care,
Bill
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