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Re: Analgesia for Vag Hysts From: Michael J. Wolpmann, MD (elvisdoc@comcast.net) Sat Sep 6 07:59:29 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. Ainsworth: "Re: Didelphys uterus and VBAC" Previous message: Michael J. Wolpmann, MD: "Re: Mirena IUD with Continuous ERT?" Hi Lynn, Sounds like overkill and possibly could create unseen bleeding after cuff is closed. As you said, TVH and LAVH typically have minimal postop pain. Toradol has proven to be the best pain med for postop pain IME. I give Toradol 30mg iv in Recovery and give them Vicodin po postop with Toradol 15mg q 6 for breakthrough pain in the first 24 hours and find it works well. Many go home the next day on OTC Motrin. I find that Anesthesia wants to give them PCA's and continuous epidurals that tend to keep them in bed, not ambulating, and thus in the hospital longer than they need to be. Although they mean well, their perspective is not congruent with ours or the patient's, many times. good luck, Michael At Fri, 5 Sep 2003, Lynn D. Montgomery, M.D. wrote: > >Heh y'all, >Another new one on me today. I was just about to begin a vag hyst when >the anesthesiologist asked me if I was going to use the "new" technique >of injecting the pedicles, as I did my hyst, with local anesthetic. I >said "say what". He then told me that because of difficultly >encountered in controlling postoperative pain following a vaginal >hysterectomy "several" gynecologists were using this technique. When I >asked for references, he simply told me that it came from the University >of Washington. > >I responded with the following points: > >1. I have done hundreds of vag hysts and pain typically isn't a problem > >2. Injecting into what are primarily vascular pedicles would seem risky >to me > >3. If there is concern about post-op pain management, then why not do a >combined anesthesia with regional/duramorph followed by general or even >a epidural PCA. > >He simply responded by telling me that he was only telling me what was >the "newest" technique for a vag. hyst. > >Any comments? >Lynn > >-- >Lynn D. Montgomery, M.D. >Rocky Mountain Women's Health >2835 Fort Missoula Rd., Suite 303 >Missoula, Montana, 59804 >406-549-0978 >fax 406-549-0987 >e-mail: apgar10@montanadsl.net > -- Michael J. Wolpmann, MD, FACOG, FACS Bayside Gynecology, P.A. Venice, Florida Next message: Dr. Ainsworth: "Re: Didelphys uterus and VBAC" Previous message: Michael J. Wolpmann, MD: "Re: Mirena IUD with Continuous ERT?"

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