Morphine alternative for valve surgey

[Val]

I am going to the surgeon on Monday to schedule my second aortic valve replacement. The part of the surgery that worries me the most is the morphine side effects. After my first surgery I woke up vomiting and with vertigo, not good with OHS. They gave me a stomach pump and medicine to help with morphine side effects, but I still had dry heaves. The vertigo was so bad that I could not open my eyes. During my hospital stay I would try to go as long as possible with out using the morphine until the pain would become unbearable.

Has anyone else had a similar experience and found an alternative drug? I had my first surgery 8 years ago at 49, I had a bicuspid aortic valve replaced with a bovine valve and an ascending aneurysm repaired.

Thanks,
Val

 

[Agian]

Pethidine could be an option. I'm sure there'd be alternatives to Morphine for you.

I've had vertigo and can vouch for how terrible it is. Maxolon did nothing for it, but Stemetil made it go away.

 

[Agian]

Btw if you've already had your aorta repaired, couldn't your surgeon go in from the side between your ribs? I ask because for simple valve replacement they can do it this way. Unless they need the full sternotomy the remove the sewn in old valve. If the op is less invasive, you might need less pain relief.

 

[Debbrn]

I had the same problem with morphine during my last heart surgery. I also had a morphine pump. I was on a very low dose of 0.7mg. I used it very little, but 5 minutes after pressing the button I had dry heaves. They first tried giving me zofran to counter act the side effects and it did nothing. They then tried a scopolomine patch. It did wonders. I never was nauseated or had vertigo again. The other IV narcotic pain medicines are dilaudid and demerol. Demerol is not used much anymore because it lowers the seizure threshold as it accumulates in the body. In the past it was used all the time and I never saw any problems. Some docs will use toradol for up to 3 days after surgery. It is a non narcotic pain reliever they helps on it own, but it also tends to help the narcotic work better.

Debbie

 

[Val]

Thanks Agian
I don't know, I'm just meeting with the surgeon Monday, the same one that did my original valve. If they can go through the side that would be great. I also always try to avoid pain killers because of the side effects.

I had a echo on Wednesday, my cardiologist set me up with an appointment for Monday and told me to take it easy till then. He would have gotten me in sooner but for the 4rth of July. It is all very sudden. He said that the valve was almost completely blocked and that that I was having leakage around the outside of the valve because of the pressure. Doesn't sound good to me.

 

[Val]

Thanks Debbie for the info. I want to go in Monday fully informed so I can discuss this with the Docs. Once you're in the recovery room it is too late. My surgeries are at a teaching hospital, they are great with techniques not so good with patient care.

 

[SuzanneSLO]

At our pre-OP meeting, my husband let my surgeon know that I had a bad reaction (nausea, dry heaves, plummetting blood pressure) to morphine when I had abdominal surgery 20 years ago. My surgeon told us that they would use Fentynal, which is more powerful than morphine but less likely to cause nausea.

I still was nauseated in ICU, although it was not an all encompassing miserable feeling. Mostly my vomiting reflex keep being triggered whenever I tried to do anything and each time it felt like something of a surprise. It stopped by the time they transferred me to the step-down unit the next day.

But my pain was really well managed with pills and only a few of those.

Best of luck to you on your procedure and on to a speedy recovery. -- Suzanne

 

[tom in MO]

I asked as I was going under what they were giving me. I got a cocktail on the table, but morphine was not one of the drugs. It did include Fentynal. After surgery (BAV replaced with mechanical) I was not on morphine and had no pump, but I was on a synthetic opiate, one oral and one by injection for the first day, just not sure which one. I got oxycodone afterwards as needed. I belive they are all opiate related though. They gave me anti-nausea medications w/o asking and changed them during my 6 day stay as I got better.

You may want to talk to your anesthesiologist earlier than the day of surgery. This used to be the practice, but now you see them right before.

 

[Jkm7]

Both of my surgeries at Mass General, I spoke with anesthesiologist day/evening prior to my surgeries. I am fortunate to tolerate almost all meds with no problem but were I someone with a heavy sensitivity, I had ample opportunity to discuss my previous anesthesia history with the anesthesiologist. I don't know if this is the case in other teaching hospitals but it is a good practice for patients to have that opportunity to meet and talk

 

[Val]

Thanks for all the good information. Val

 

[yotphix]

I had morphine in the ICU and no problems with it, but in under 24 hours I was sent up to the recovery ward, and there they put me on Oxycodone, which made me feel awful. When I told them I couldn't do that one, they switched out to Hydromorphone, (I think that may also be known as dilaudid?) which is a semi-synthetic morphine derivative. Would that work any better for you? I can tell you, it is a lovely drug, for me at least. I asked really nicely but they wouldn't give me any to take home. If I ever have another surgery you can bet I'll be asking for that pill every 2 hours, as they said I could, and I'll pocket every second one! (I only needed them every four hours, but I was sent home with nothing more than a T3 prescription. It wasn't really enough.)

 

[Val]

I have heard about Dilaudid and I would really like to try it. The problem is, so I have been told by a doc, is that women my age with a bad valve are assumed to be drug abusers. It gets worse, if you say that you don't want morphine, then they think that you are "drug seeking". Evidently, drug abusers know that if you refuse morphine then you might "get the good stuff". I am going to have my cardiologist intercede for me, so that I won’t get the "drug seeking" label. I am not sure that this is a big problem in a private hospital, but it is in public ones in Florida. All the uninsured come there and the staff has a tendency to make assumptions about patients. The first thing I do when I am in for procedure is to tell those involve that my condition was congenital and I can see the change in the way I am treated.
Morphine was the worst thing about my first AVR, I woke up vomiting. They gave me something for nausea which did not work, so then they put me on a stomach pump. I could not open my eyes because of the vertigo. I would try to not take the Morphine for as long as I could take the pain. I told the doctors that Morphine was a problem and sometimes they would proscribe something else, but in a teaching hospital the attendings are on a rotating schedule and Morphine is the drug of choice. I now tell doctors that I am allergic to it and it is on my chart that way, so hopefully I will be protected from it.
My surgery is schedule for next week and I am going Mechanical this time. I am not looking forward to a life on Coumadin. It is not a good fit for me, I install landscapes and hardscapes, so bumps and cuts are a way of life, but I am excited about getting my energy back.
Thanks for all the info.

 

[tom in MO]

Don't worry about bumps and cuts. You will still heal the same. The only difference is your bruise will be a little bigger and it will take more time for your cuts to stop bleeding.

I cook a lot and cut myself good occasionally. I find that for the really bad cuts, a bandaid doesn't put enough pressure on the wound and I am to impatient to wait and put manual pressure on the cut. So I use a gauze pad with an anti-stick side and tape it down good to put a little pressure on it.

 

[AgilityDog]

Hey, my sister is a drug rep. She represents a new IV tylenol which has been used in Europe extensively. She herself just had open incision abdominal surgery at Cleveland Clinic and arranged to be given the IV Tylenol instead of morphine, etc. She and her surgeon were very, very impressed with the drug. AND best part, because the tylenol does not shut down the digestive tract the way morphine and other opiates do, she was able to go home only 3 days after her surgery, instead of the anticipated 5 to 7 days.
Check it out with your surgeon. They have to start the drug while you are in recovery, and keep it available. Cleveland Clinic does its own tests on drugs, before adding to the available mix, which is why she had to make special arrangements - they are still testing for their own use. But other hospitals have it in the regular availability. AND it's not expensive for a new drug.

I hate oxycontin etc. and claim to be allergic, too. I hate the constipation from the morphine. I'm going for the IV Tylenol when my pacemaker gets changed next year! I am a believer.

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