I am due to have a TLIF fusion Jan 27th.. I have a severe DDD at l5-s1.. I am concerned with the post-op pain in recovery and after in general.. I havent met with my anestisiologist yet but worried because I am opiate tolerant and not sure how to ask for meds for post-op recovery and while on the PCA.. I have had morphine after surgery b4 and dilaudid also.. The dilaudid worked alot better with the pain than the Morphine.. They were giving me Fentanyl in recovery and it suxed for me.. I know they usually use morphine in the PCA at a 6-10 min lockout and 10mg per hour.. Not sure about dilaudid but assume it would be 1/10 of that because of its strength.. Has anyone had similar surgery and what was used in recovery to control the pain? What was used in the PCA pump? I know after home the oral meds will be Percocet 10/325 and zanaflex.. The hospital is my concern the 3-5 days i will be there.. Thank U!!!!

Dear TLIF,

I have not had any spinal fusions but my husband has had 2. The first was not successful but the second with a top NYC surgeon was a walk in the park. And they took every stitch of what the other doctor did apart and did the same thing over just with a different technic. The first surgery was in 2002, then I had an accident and was injuried and put back together over a 4 year period. He meet this top surgeon while I was in the hospital make a long story short in 2006 in had the revision.

As far has his medication it was an issue. When we had the surgery the surgeon was concerned because of all the medication he was on and I think if he did not know us I don't think he would of done the surgery due to my husband's use and it was not abuse it was the amount he was taking. The biggest problem was him being on the Fentenyl patch. As far as his pain when he was in the hospital for 6 days he stayed on his regular meds., and kept him on a morphine pump and then just to his regular meds. and he was fine. The best is that today and since 2009 he is medication free he doesn't even take a Advil. I think in our situation we just wanted a good doctor and to do a surgery that was not going to make him worse. Which is a concern with spine surgery. I don't know what part of the country you live in but he was a patinet at the Hospital for Special Surgery,NYC, Dr. Frank Cammisa, head of spine surgery. The gentlemen is an amazing doctor.

I will say one more thing. When the surgery was over and he was speaking with me the first thing he said was he's fine and you can see him in a 1/2 hour and the second was he has got to get off that medication. Which he did.

Today he gained a little to much weight and is losing it slowly but no back pain and he was misrable for years and overly medicated, it was a mess before the second surgery.

Good Luck

Gabbycakes

Hi ~ I've had 2 OPEN spinal surgeries, without fusion but let me tell you, they were very painful. And I'm EXTREMELY hard to medicate -- I have been since I was a child. In fact, I have awakened on the operating room table TWICE during surgery!!! So I always have to make sure the anesthesiologist knows that!

During the stay in the hospital, they gave me Morphine drip. For meds at home all they gave me was Vicodin!!! Let me tell you that that was NOT adequate, but that's all my surgeon would give me. I couldn't ask my PCP for something else as he would think I was a drug seeker. So believe me, I suffered.

Both surgeries failed, and I'm now disabled and considered inoperable. The last surgery was in 1995. Sheesh. Best of luck and God bless. Hugs, Lee

First, I'd be more concerned that my pain be treated adequately rather than which drugs may/will be used. Concerns should be addressed to the doctor who has been manging your pain (and prescribing meds) to communicate your history to the hospital & surgical staff/team.

Second, most (American) hospitals today have some kind of Patient Bill of Rights Try google - many are available online. Some of these documents include the right to have pain adequately addressed - others do not. The hospital where your surgery will take place should be able to provide you with a copy of any documents/policies pertaining to post-op pain management.

Third, most (American) hospitals today also have some kind of patient advocate whom you may also wish to contact in advance to discuss your concerns. This person may be able to expedite communication to the right people.

Best wishes on the surgery,

Doc

Great point Dr. Smith,love that name, each time we or my husband where in the hospital in NYC yes a patient advocate did see us and if I remember correctly she was introduced when I/we where admitted and saw us all the way throught.

Gabbycakes

Two years ago I had my 5th lumbar surgery with three having fusion. This last surgery was done by a younger doc...I don't know if he just is more compassionate or what but he really medicated me well during my recovery. Yes, we tried many different drugs before we found what helped but still I have had no experience with a doc that was so concerned about my pain.

I have a lot of junk going on with my lower back...Spina Bifida...fractures...so we still medicate me for pain however not with a supper strong pill. I have been in pain all my life so it has become a real part of my being. I sometimes will call my pain my best friend...never betrays...always stays in touch and visits on a very regularly...a blessing...the blessing is in the wisdom I have gained is endurance. I have learned that I can't do everything all the time. Fortunately I dear hubby...loves me and is patient with me. That's all I ask from him. He doesn't care how clean the house is because he wants me to slow down and rest and just not worry about the dishes or whatever.

Yes, we are all in pain and some can endure better than others. I used to have a very high pain threshold but that has changed. I do get very frustrated when my pain changes my plans and sometimes I just buck up as my son would say and push on. Sometimes pleasure, whatever that might be...weather visits with friends or other social events are better even if it is painful...better than sitting in my pain at times.

You will be in my thoughts and prayers as you prepare for surgery...

Dear TL,
I do think opiate tolerance is something to be dicussed before you go to surgery. I did not do this and I did have trouble. Alot of trouble. My neuro surgeon and pain doctor did not communicate at all. The only person who understood I had a tolerance, was my night nurse, who tried to come to my rescue. When I got home, my morphine I was off, and the new med. oxcy contin replaced it. I stayed an extra day in the hospital because I was afraid I would take more meds. than I should. My pain was not in control those first two days. I had more trouble at home too. I learned a valuable lesson to ask more questions of your doctors before you go to surgery. My outcome was good and it did turn out OK, but it hurt alot. I wish you all the best and hope you ask all you can of your doctors. Ginnie

I I am having surgery in Charlotte, NC and my neurosurgeon is actually name DR. SMITH.. Thats hilarious.. I talked to my pain doc today and he said he would be sure to see I am comfortable regardless of how much medication i need.. Dr. Smith is a morphine man and Dr. Park the pain doc said he will suggest 1 1.5 mg q 6 mins equal to up to 15 mg per hour and IV shots prn.. He said it would not be an issue to switch the PCA to Dilaudid at .2mg q 8 min or 1.6mg per hour and 2mg IV during switch out of meds.. I will still meet with anesthia doc on the 19th and discuss PACU protocol of meds used.. thanks for the messages..

Dear TLIF12,

Wanted to see how your surgery went on the 27th. Hope you are recovering well and wish you all the best.

Gabbycakes

[I am sorry to hear you have to have the surgery, and I hope that it turns out Good for you. I have had several fussions, the last was C3-7. There were indeed pain issues in the hospital. There was no communication between my neuro and my pain specialist. I had more pain than I should have because I was opiate full for 8 years. The only one to listen was the night nurse who insisted on the doctor being called for more meds. I also had trouble at home, when my meds ran out, and I was then not sure if I should resume what I had been on pre-surgery. My pain specialist would not treat me until the surgeon released me. The Neuro would not give more as it was stated he only dealt with the physical pain of surgery. So I was out of medication, and not due back in to the pain specialist for weeks. Well I did get it straightened out, after some real days of suffering withdrawl. This would not have happened if I had taked to both these physicians ahead of time. Take control and find out before hand so there are no complications when you are at your weakest. Good luck ginnie