my spinal fusion story

[pediatriclpn]

I just had spinal fusion a few weeks ago. I had lived with the lower back pain for a year and a half. I have been an LPN since 1992, so I have some idea of what would happen and how my pain should have been managed. My neurosurgeon had planned on caging L5 due to spondylolythesis and fusing L4L5 and L5S1, in the OR before they put me under he stated that we may get away with just fusing one level. And the plan was 4 to 5 hours in surgery. My poor husband waited 8 hours to hear from the surgeon. They found more things wrong with my spine than had shown up on the xrays, CT scan, or 2 MRI's. He caged L4, caged L5, fused L4L5, fused L5S1. I have 6 screws, 2 cages, and I am unsure of how much more hardware back there, because I was so out of it. I went into the OR a little after 7 in the am, after being in the hospital at 5am. I came out of recovery after 9pm. I woke up still intubated because my pulse was 150. When they took my to the floor. I got to say good nite to my husband. They hooked up my CPAP, with O2 in line, but didn't do it right so my sats were 60. And I remember the nurses and the aide being very upset. They left me on my back all night except to check my dressing. I didn't know where the button for my pca pump was, or where my call bell was. The next day I had a student nurse she was my , she will make a fantastic nurse. My pain level was a 10/10 most of the day. She got her instructor, and they got my nurse to call the surgeon to get percocet for breakthru pain. Unfortunately since the cafeteria didn't send a tray, I didn't have anything but water in my stomach. So immediate emesis. They then got an order for IM Tigan. Thank you, hallelujuah. The doc covering for my surgeon came to visit, I told him the robaxin for the muscle spasm wasn't working, so he ordered valium. So along comes the 3-11 nurse. Comes in and says " We have to remove the pca pump and put you on po percocet now. I didn't question why, because finally I was about a 3/10 on pain scale finally. This was about 5pm. Later that evening I did ask her and she said the MSO4, the valium, and the percocet were too many narcotics for my body. And she was uncomfortable. OKAY, I understand that, but to remove a pca pump less than 24 hours after surgery??????????????????????? Is this normal? Saturday and Sunday come. I get sick with every dose of percocet. Am still on liquid diet. I have gotten to the point that I am afraid to put anything in my mouth. I get out of bed on Sunday and walk for a short period, refuse to on Sat. I go for 10 or more hours with no pain pills, because the nurses don't want me to thow up, but don't call the doc. I have also been 4 days without my Cymbalta which I was told would be supplied to me in the hospital. By Sunday morning I am having withdrawal symptoms, tell the nurse, "Well I would have to call the doctor to get the order for this, can't your family bring it in from home?" Called my husband hysterical, he brought my meds, within 2 hours my ungodly headache finally went away. By Monday morning my neurosurgeon came to see me, and couldn't believe how bad I looked. I begged him to do something because my pain had not been controlled since I came out of surgery Thursday night. My husband explained what had been going on all weekend. The neurosurgeon talked with the nurse manager on the floor. I had demerol and vistaril with 5 minutes, and every 6 hours, with toradol every 4 hours, within 12 hours I was asking for my catheter to be removed, asked to sit on the commode, had a BM, wanted real food. Got out of bed all night whenever I had to pee, and even once did it myself because my call bell wasn't answered quick enough.

I do have to give kudos to my aides, especially the one I had Sunday night. I was supposed to have my percocet at 5 am, I rang the call bell, he answered it went to tell the nurse, she didn't bring it in till after 7am. I must have been on the bell every 15 to 20 minutes in between times, please help me become comfortable, help me turn, put a pillow here, there, etc.He got me ice packs etc. He never once showed any annoyance for all my neediness. The next night when I saw him I thanked him to no end. MY question is for those of you nurses working med surg, ortho etc. How do you handle someone after spinal fusion surgery. And thanks for reading my long post.

[Lisbeth]

At our hospital, all post-op patients are offered pain medication every 4 hours for the first 24 hours after surgery. Fusion patients are turned/"logrolled" every 2 hours. We have "pathways" where the Dr orders are preprinted on the order sheet, and the Dr just checks off what he wants. There is an option on the order form to "D/C PCA on POD-1". It looks like the pm nurse you had just followed orders and didn't use nursing judgment. On our floor, we usually D/C the PCA after a couple doses of the po meds, to make sure the pt tolerates the po well. If the pain is tolerated with the pills, the patient usually ends up not using the PCA anyway. It is up to the nurse to make sure the medication is the right route for the patient.

I am glad that at least you had good nurses aides, they don't get the recognition they deserve sometimes. There are times when their interactions with patients can prevent really a cranky patient.