Pros and cons of epidurals re: recovery?

[My3labs]

What are the pros and cons of getting a epidural for multiple adrs ?

[Jstuckey]

I don't know scientifically the details of pros and cons other than basics of the invasiveness of it, but speaking from experience, I'm glad I got one (1 level ADR, 1 level fusion lumbar). I had it in for 2 days, which I'm sure there is some slight risk of infection, possible nerve damage, things you could look up on the internet... I did have a bit of a blood pressure dip the first night out of surgery and they turned the epidural down a bit while I slept. I didn't even know it, other than I was confused as to why I was getting some feeling back in my legs. I guess I'll never know what the pain would have been like the first two days without it, but I thought it was worth the 150 pounds (incredibly cheap in my English hospital!). I got a lot of attention from the anesthesiologist for both this and general pain control once it was removed. Maybe a con is that it may extend your hospital stay a bit? I didn't get up to walk, of course, until day 3. I probably would have been up day one without it.
Thumbs up from me.

[laid up doc]

i only had one level, but for me the risks would have FAR outweighed the benefits. i was in way less pain than i was preop - mostly just aching. my back didn't hurt AT ALL. i got exactly 2 IM injections of a cousin of demerol, along w/ tylenol/ibuprofen. anything else would have been total overkill and would have definitely prolonged my hospital stay (i was walking at 18 hrs after surgery).

[annapurna]

Totally depends on your anticipated post-op pain. I was up and walking an hour or two after my single-level L5/S1 ADR. When I woke up from anesthesia and finished the mandatory time in recovery, they walked me back to my room. It was great except for the post-anesthesia nausea. I'm sure it wouldn't be allowed these days (that was back in 2002). As the nausea got worse, I was up pacing the halls half that first night - no pain anywhere even without med's. I never needed more than some oral med's on day two and lots of walking and resting on my hands and knees to stretch my back. I was REALLY lucky, but have heard similar experiences from folks with way more pathology pre-op.

Personally, the invasive nature and infection risk would seriously dissuade me from an epidural for post-op pain control only. The IV opiates I got for my second cervical ADR literally wiped out every pain in my body and kept me in a state of calm sleepiness the whole night post-op. That second cervical surgery was definitely involved since I had tons of pre-existing scarring from the previous cervical ADR, but the IV med's kept the pain away totally and may have been more than I needed. (after the fact edit from Jim, Laura's husband: the IV meds were more than what she needed and had her more than a bit loopy that night, even after the dosage level was dropped twice)

Have a chat with your anesthesiologist pre-op and work out a post-op pain control strategy. If they really think the epidural would be necessary, then consider it, but, if you could get by COMFORTABLY with the oral and IV med's, I'd use those and skip the epidural. Just my opinion.

BEST OF LUCK!
Laura

[laid up doc]

people also underestimate the risk of being in bed and being in the hospital - risks of blood clots and infection increase a ton with increases in those 2 things.... even w/ prevention strategies in place.

take it from someone who sees the post-hospitalization clots and infections constantly.... and has seen more than 1 or 2 people w/ permanent problems after an epidural.

it's a great tool when needed - but imho risk is greater than benefit for ADR.

[My3labs]

Thank you for all your response i dont think i would have one for i made it through child labor twice with out any drugs i think i can do this with out the epidural and plus i dont think i could lay in bed for 3 days staight i would go crazy .. Heck i go crazy laying around doing nothing when my back is acting up. But thank you all for your response.

[laid up doc]

i have not (?yet - tbd) been through labor... but i'm sure it's at least 10-20x worse than regular ole post-op pain!!!

[Jstuckey]

I actually had natural childbirths, but was fearful of the fusion pain I'd read about so I had my first epidural with this surgery. In all honesty, I truly believe the type of fusion I had probably would not have created the pain like I hear regarding "standard" fusions done in the US. I think the stability of my device (STALIF TT) and the fact that it's contained in the disc space, rather than cages/pins on the outside of the vertabrae make it a less painful recovery. (That's what the product claims, and that was my experience too). Seeing as how my epidural was out on day 3, and when it was removed I had no back pain or radiating leg pain (just incision pain), I probably didn't actually need it. I was low risk for DVTs being healthy and thin, and I was still able to move my feet (just numb from the mid abdomen to thighs), plus the graded pressure stockings running all the time, I'm still glad I had it. I don't regret it, but it probably was overkill in hindsight.

[laid up doc]

Jstuckey -

just to clarify... having major surgery is a risk factor for DVT.... especially when your iliac veins are mobilized or even touched (any surgery above L5/S1).

general health has nothing to do w/ it, and it's unclear at what level obesity is a factor and whether it's actual size or less mobility.

i've seen athletes have DVT's after arthroscopic knee surgery, otherwise healthy people get one after a transcontinental plane flight... and if it becomes a pulmonary embolus, the mortality rate is 20%. it's not a trivial matter.

(and yes, in case you can't tell, DVT and PE are with my area of specialty!!)

[Jstuckey]

Thanks for the info. That differs from what my surgeon said. Glad it's behind me!