Pump or Epidural.... what are your thoughts

It's Sunday, my surgery is on Thursday and been wrestling with this decision over the weekend. Here is the situation:

I am having TAH, plus bladder sling and extension repair work done for mulitple prolapses. Here is the complicating factor, I have sacral nerve damage. After testing, they haven't been able to find the cause of the nerve damage (no MS, spinal tumor yeah). As a result of this nerve damage, I often do not have the urge to empty my bladder, nor do I empty it (I have high urine retention). This nerve damage has also affected my sex life (very few "O") and sometime my bowel. I realise that I am risking more nerve damage with the surgery, but the prolapses are severe and have to get fixed.

I was concerned that with the epidural, I am increasing my risk of additional nerve damage so I was leaning towards using the pump. I found out at the pre-op that the epidural provides better pain control, and this is what my doctor prefers. Now, I don't know what to think. (and I can't call the dr until tomorrow). What are your thoughts on this matter? Would you use the pump over the epidural ( I am also allergic to morphine).?

Thanks
Levanah

Hi! wow sounds like you have a big decision to make! I had an epidural with my 2 c-sections and loved it as far as the pain control went you feel NOTHING from like below your ribs down until it is turned off! I had a PCA pump with my hyster by chioce, and I liked it to! It is controled by you but it WILL NOT let you overdose or anything like that! I was insistant on getting up and about ASAP and doc assured me that The eipdural would not hinder that or make it longer before I could get up but my bull headedness I insisted on a PCA and my doc has learned not to argue with me unless it is life threatening, we have been together long enough he knows he'll loose the battle!

I don't know if this is any help or not but it is my opinion and I didn't mind the epidurals or the PCA pump! and I don't know if you being allergic to Morphine would make the choices for you any different or not! Does your doc know you are allergic and if so what is his take on what he feels?

Best of luck to you!

Love & S

Sharon

Hi Levanah

I, too, have had both epidurals and PCAs. I've heard a lot of different opinions here at HS and everyone really does what they feel is best. For my hyst, I used a PCA(not with Morphine because I'm allergic to it) and I had great pain relief. I was able to get up fairly soon after surgery and walk around. I don't know if you can walk around with the epidural (I don't remember from my other surgeries).

The other item I would take into consideration is what you have going on with your spinal nerves - you don't want to aggrevate that problem!

Here is a Link that talks about making the decision:

https://www.hystersisters.com/vb2/sho...pidural+or+pca

Just a few thoughts - hope they help

Sending you a big and wishing you well with the surgery! Soon you will be a Princess too!!

Patty

Hi Levanah

I dont know if this is going to be any help but I had a TVH + TVT (trans-vaginal tape - I think thats the same as your bladder sling) I chose to have spinal block which is similar to an epidural but does not last as long (aprox 3 hrs enough for them to operate) I chose to have voltarol suppositories 100mg, you can have them pre or post op (they are a very good pain killer and last for aprox 12-16 hours) I am used to voltarol tablets and did not want to be given anything else c/o pain in bowels ( lots of pain meds cause me to suffer from constipation) another tip I was given was to take stool softners and lax and to drink plenty of water (believe me this helped alot ) I also took my cd/tape player and relaxation music into theatre to help me to relax and visualize that I was some where else ie: nice sandy beach, sunny day, tall dark handsome man pouring me cocktails and rubbing in sun tan lotion

well it worked for me

I did notice other ladies on the same ward as me using the pump - the only thing I noticed were that they were not as mobile as the pump restricted them, they also had surgical stockings on which I did not as I was up and about as soon as my drip and drain were removed

Take care, wishing you all the best for your op

I think you will be better able to make this decision when you talk to an anesthesiologist. I know a couple who wouldn't touch your back with a ten foot pole, let alone an epidural. However, knowing the particulars of your situation is important and it's really the anesthesiologist, not your who usually makes this decision. Your doctor may have a preference as to how he likes his patients to be anesthetized, but it is the anesthesiologist who has the responsibility for making the decision.

I am also allergic to morphine but found that Dilaudid worked, as it does for some patients who have a morphine allergy. I used it in an epidural that worked great. However, I mostly used a pain pump for my post-op pain for the hysterectomy. ( That time the epidural fell out after a few hours. And as sometimes happens, it wasn't giving good pain relief, as the coverage was uneven.)

Whatever happens, I think you can be fairly sure that you will have good pain control with minimal risks involved once your anesthesiologist if fully aware of your situation.

Hi, I had my TAH May 12th. I was knocked out completely and then hooked up to a PCA pump, which I never used. I am not alergic to Morphine but I can't stand the way it makes me feel, or any of the other narcotic drugs do too. I would rather endure the pain, although I didn't have a lot of pain post opp. The Dr. did a new procedure on me that perhaps you have not yet heard of. It is called a Lidocane bath or pump. What they do is they insert a tiny (and I mean tiny) tube into your incision site and "bathe" the area with a numbing drug. In my case they used Narcon. I am alergic to some novacain type drugs, but they have tons of different kinds now-a-days so no problem there. Anyway, when I woke up, I was relatively comfortable. I never pushed that morphine button, in fact they removed the pump the next day. The Dr. and nurses kept asking me why I wasn't using my pain meds and finally I just asked for Motrin. It took the edge off the pain and I was able to handle it quite well. The lidocane bath stays in place for about 2 days until it gradually dries up. When they remove the tube, you feel nothing. If you are wondering about my pain threshold, it is very low. I have always been called a weanie. I really think that the incision numbing thing was what did the trick for me. I was able to get up the same day as my surgery and I went home 1 1/2 days early. It is a really new procedure and not all hospitals are using it, but I highly recommend it. I had a c-section 11 years ago and waking up from this was very similar, except for the pain. The pain from the c-section was far worse in the recovery room but the whole surgery and recovery feels about the same.
As for your other repairs, I am sorry I really can't help there. I was able to have my cath. out the next day. My guess is that you will have yours in for quite some time, perhaps even after you leave the hospital. With your nerve damage problems, I would be very wary of doing the spinal thing. Please talk more with your Dr. and the A man about this. You want to be comfortable with your choice and it sounds like you are worried too. Just remember, the choice, ultimately is yours, don't be affraid to say what you you are feeling. Good luck to you!

hugs, val