Question on epidural

loisane · Jul 7, 2005

aspenice, I appreciate your apprehension. I have taken care of several patients in situations similar to yours, but never for OB.

I think you will feel better once you have a heart to heart discussion with whoever you have chosen to assist with your delivery. Have you considered a nurse midwife? If your personal health is a good match for a midwife assisted delivery, you might find that they are very skilled and committed to a natural birth process.

If your health needs dictate it, or if your pregnancy is complicated, you will need a physician OB. Despite your best laid plans, this is a possiblity at any time. I know this is a source of your apprehension. Don't let your apprehension cloud your judgement when/if it is time to switch to plan B.

About epidural anesthesia-one of the advantages of this technique is the ability to use lower doses of narcotics, delivered near the spinal cord. The drug acts closer to the source of the pain, and doesn't have to sedate the entire body and the brain. I am not an addiction expert, but I would think this might reduce the impact on your recovery.

Speaking of addiction experts, you could benefit from their expertise. In my experience, recovering addicts made a detailed plan with their NA sponsor, counselor, etc. prior to surgery. You are not the first person to face this situation, they have knowledge that can help. In my cases, the patient and I jointly came to an agreement of which drugs were allowed, and which to avoid. I also provided them with documentation of what drugs I used, which they needed because of required urine testing.

Hope this helps some. Good luck to you.

loisane crna

kmchugh · Jul 8, 2005

I will be giving birth in Oct. of this year and am worried if I need a c-section. I plan to have natural childbirth and can't take any benzos, tranxs or pain meds of any kind. I was addicted to the above due to a mis dx. I am very scared b/c I lost alot of faith in the medical community but that is another story.
Suggestions please.

My first question is whether you have any indication that you might need a cesarean section. Don't borrow trouble you don't need. However, be aware that as anesthetists, we often give narcotics to patients in surgery with a prior history of addiction. When these narcotics are given in the presence of real pain, the potential for readdiction is pretty small. But, I can understand your concern.

In your position, this need not be a big concern. I do epidurals for patients in labor as well as patients having cesarean section all the time. Very rarely do I add narcotics to bolus doses that I put in the epidural. On the other hand, the infusions at our hospital are preprepared, and all contain fentanyl. However, low-dose narcotics administered to an epidural diffuse into the bloodstream very slowly, so blood levels of the narcotic are extremely low, and patients almost never have any systemic effect. Hence, readdiction isn't really a problem.

If you need a c-section, spinal and/or epidural anesthesia is greatly preferred over general anesthesia for the safety of both the mother and the baby. Generally, when I prepare a patient for cesarean section, I use 15 to 20 cc of two percent lidocaine with a little epinephrine and nothing else for the surgery. With this dose, I achieve a surgical anesthetic that lasts about two hours. Postoperatively, we use a 24-hour infusion of ten micrograms per mil of fentanyl, and infuse it at 8 to 12 cc per hour for pain management. You will not want to go without pain medicine after a c-section. Again, though, the potential for readdiction to narcotics when taken in the presence of pain is pretty low.

My suggestion is that first you have a discussion with your obstetrician as to the potential for your needing a c-section. If it seems as though the potential is high, or even if not but you are still concerned, ask your obstetrician to set up an appointment with the anesthesia provider at the hospital where you will have your baby. Let the anesthetist now your concerns, and discuss your options with him/her.

Kevin McHugh

gaspassah · Jul 8, 2005

if you are in any type of recovery program or are tested regularly check with your case manager etc. especially if you are a nurse. i had a friend (truly) who was in diversion went to see his physician was prescribed a med. but since he didnt check with the BON before seeing the doc he had to do the diversion program all over again. 4 years worth.

d