Pain control after PD catheter surgery

[RCA]

My mom is getting the PD catheter placed on Friday.  I asked about pain control after the procedure.  The surgeon said tylenol is sufficient.  What is your experience?  Did you just take tylenol after the procedure or did you require more powerful drugs, such as perscription vicodin or percocet? 

[Red from Canada]

Tylenol is all she will need.  You have to be careful which drugs you give a dialysis patient.  Only use ones prescribed by your nephrologist.  Drugs that are safe for normal people are not always safe for kidney patients.

[george40]

My Drs. sent me home with a prescription for oxycodone. When the dr. mentioned "tylenol" maybe he meant prescription of "oxycodone w/ tylenol" Regular otc tylenol would not have done the job for the first few days for me.

[djgaryb11]

My surgeon also had me on oxycodone ( generic percocet) after my surgery.  I had an umbilical hernia repaired at the same time as my surgery for my PD catheter...so that also created some additional pain...and I was hurting for about 2 days after my surgery...even with the oxycodone i still had some pain/discomfort....I was able to walk and get around, but getting in an out of bed was pretty painful....by the 3rd day after my surgery, it was not that painful, just kinda sore.

[Ken Shelmerdine]

I don't know what tylenol is but I found ordinary pain medications that you would take for a headache is sufficient. The most popular of those kind of drugs in the UK is paracetemal which  I was prescribed.

[MiSSis]

I can't remember now exactly what I would have been prescribed for pain since my catheter was inserted 5 yrs ago but I'm sure I required something stronger than Tylenol.  I'm thinking I would have had either Percocet or Darvoset or some derivative.  Anyway, if it won't cost your mother too much, I'd probably ask for something a little stronger to have on hand just in case.  I'd sure hate to be at home on the weekend and be in a lot of pain.  That always seems to happen when the doctors are the least accessible.  My motto:  Better to have it and not need it than to need it and not have it.

Good luck to your mom on Friday.

[mikey07840]

Ken, Tylenol is a brand name of the generic medicine acetaminophen which is the same thing as paracetamol. I don't know why it is called acetaaminophen in the USA and paracetamol in other countries. In the United States Tylenol or the generic acetaminophen is available without a doctors prescription.

[Ken Shelmerdine]

Mikey I thought perhaps that was the case, just wasn't sure. Thanks.

[RCA]

Thanks everyone.  I'm going to see how my mom is doing after the surgery.  If she starts to feel some discomfort when we're at the hospital, I may ask for a prescription just in case : ) 

Ken, question for you.  I was just reading in another post that last year, you had 2 days off from PD.  Are you still following that schedule? 

My mom's situation is similar to yours.  She's at GFR 10% and doesn't have symptoms.  The doctor said perhaps when we start, she can do 2 exchanges a day and that may be sufficient for her.  After reading your post, maybe we can ask for a PD holiday like you did : ) 

[Ken Shelmerdine]

Ken, question for you.  I was just reading in another post that last year, you had 2 days off from PD.  Are you still following that schedule? 

My mom's situation is similar to yours.  She's at GFR 10% and doesn't have symptoms.  The doctor said perhaps when we start, she can do 2 exchanges a day and that may be sufficient for her.  After reading your post, maybe we can ask for a PD holiday like you did : ) 

Yes RCA I do Sunday to Thursday each night with Friday and Saturday off. I am also dry during the day. It all depends on what they call adequacy. At my clinic they look for an adequacy figure of about 1.8 (don't know what the figures mean) My figure is 2.7 so they say that my dialysis is more than adequate so they let me have my 2 nights a week holiday. My GFR is down to 6% but luckily because I have full fluid output I don't get bloated.

So get your mum's adequacy checked out and who knows she may be able to do the same.
Just one question does your mum have polycystic kidneys which I also have?

[RCA]

Ken,
Glad to hear that you're still enjoying your dialysis holidays on Friday and Saturday! 

My mom's renal failure is due to a complication from tonsillitis when she was very young.  She doesn't have diabetes and is otherwise healthy.  I think she'll do very well and hopefully we can have 1-2 days off PD or maybe just enjoy 2 exchanges per day.

The cycler is also an option but she is such a light sleeper, she has already convinced herself that she won't be able to sleep with the machine on.  We'll see...

 

[Ken Shelmerdine]

RCA
I have found that the Baxter Cycler is fairly quiet if you pad it well underneath with something soft like towels or better still if you have another bed in the room just put the cycler on the mattress of the spare bed and it absorbs much of the sound.

Remember also that the machine is only active during fills and drains which take about 10 to 15 minutes. There is a very slight buzzing and clicking sound when the machine is not active during dwell time but if you are still awake after the first fill (I usually am, I've never got to sleep yet during first fill) you can turn the machine off, wait a few seconds until the buzzing and clicking stops. Then switch it back on and it becomes completely silent until the next drain and fill which shouldn't make too much noise if you've got it well padded.

 I very rarely am woken up by drains and fills nowadays. I think you should try and persuade your mum to at least give it a try.

[paul.karen]

Ken a question for you.

i havePKD.  and my fluid output is fine.  I am predialysis but should be starting soon.

What do you mean by dry during the day??

And ill have to have them check my adequacy rate..

How long is your PD time at bnight?

Thx P&K


RCA hope your mom is doing well.

[Ken Shelmerdine]

Ken a question for you.

i havePKD.  and my fluid output is fine.  I am predialysis but should be starting soon.

What do you mean by dry during the day??

And ill have to have them check my adequacy rate..

How long is your PD time at bnight?

Thx P&K


RCA hope your mom is doing well.

Hi P&K
I had quite a detailed anwer for you but I lost it on this stupid laptop I'm using so I'll do it tomorrow on my other computor and hopefully anwer your questions. Posting now before I lose this!

[Ken Shelmerdine]

Ken a question for you.

i havePKD.  and my fluid output is fine.  I am predialysis but should be starting soon.

What do you mean by dry during the day??

And ill have to have them check my adequacy rate..

How long is your PD time at bnight?

Thx P&K


RCA hope your mom is doing well.

Hi P&K
Dry means that I don't carry dialysis fluid during the day. Some people with very severe kidney failure have to have a continuous dialysis hence the  name CAPD (Continuous Ambulatory Peritoneal Dialysis). For these people the Baxter cycler does a final fill usually of a stronger solution to be then carried during the day with perhaps one manual exchange until going back onto the cycler at night.

From what you tell me I don't think you will need continuous dialysis because If you have normal fluid output and no retention this give a tremendous boost to your adequacy calculation. It's also a fact that a good number of PKD patients retain high fluid output for several years after the commencement of dialysis.

My nightly treatment is 8 hours using the weakest fluid of 1.36% (For some reason it is 1.5 in the US) 3 fill and drains with dwells of 2 hours 20 minutes and no final fill because as I've said I don't carry fluid during the day.

Finally just a word about what the medics call 'Kidney Function' This is a misleading term as it a measure of glomular filtration rate (GFR) only and doesn't take into account urine production and haemoglobin levels.

 It can be quite alarming when you are told that your kidney function for example is only 10%. If your kidneys are still giving you full urine output (although poor quality as it doesn't contain much of the filtered waste products that normal kidneys produce with the exception of potassium)  and your haemoglobin level is good then your symptoms would be probably far less severe and you would  be less dependent on dialysis than for example someone with 30% GFR but with reduced fluid output and anaemia.

[TheSpleen]

Thanks everyone.  I'm going to see how my mom is doing after the surgery.  If she starts to feel some discomfort when we're at the hospital, I may ask for a prescription just in case : ) 

Ken, question for you.  I was just reading in another post that last year, you had 2 days off from PD.  Are you still following that schedule? 

My mom's situation is similar to yours.  She's at GFR 10% and doesn't have symptoms.  The doctor said perhaps when we start, she can do 2 exchanges a day and that may be sufficient for her.  After reading your post, maybe we can ask for a PD holiday like you did : ) 

For what it's worth, my wife was pretty uncomfortable/in pain for a couple days. Had a prescription for Vicodin, and probably used about four of them. Surgery was about three weeks ago and she's been doing well for some time. Just starting our training now - the first two flushes were almost painful for her, but she did her first small exhange (1 liter) yesterday and she said it was night and day - so much better, not even uncomfortable.

[RCA]

Mom had the surgery on Friday.  At the recovery room, they gave her some morphine and an oral pain killer.  Doctor gave us a prescription for Tylenol #3 and she ended up only taking one pill.  She didn't sleep well on Friday night but was feeling much better on Saturday.  Last night, she said she slept pretty well and is feeling okay today.  She said it's still tender and hurts when she coughs but otherwise, it's not bad! 

Since she doesn't need dialysis right away, we actually got the catheter buried/embedded.  There are a few studies that discuss embedding the catheter a few months beforehand and then externalizing when dialysis actually needs to be started.  Two benefits to this process is 1.  there is more time to plan and heal from the surgery...so when we start PD, we have a "mature" catheter, similar to a mature fistula.  2.  Cut down on infection rate because the cuffs will have healed pretty well by the time PD is started and less risk for infection.  The major draw back is that externalization requires another procedure...just local numbing medication...but still need to go to the hospital to take it out.  The verdict is still out on whether having an embedded catheter is the way to go but it definitely gives us a level of peace to know that we have something in place when she needs to start dialysis. 

[djgaryb11]

Glad to hear everything went well and your Mom was not in that much pain after.

[Ken Shelmerdine]

RCA glad it all went well for your mum. I've never heard of embedding the cath. Does that mean it is all beneath the skin?

[RCA]

RCA glad it all went well for your mum. I've never heard of embedding the cath. Does that mean it is all beneath the skin?

Yup...the catheter is beneath the skin.

[paul.karen]

RCA  glad your mom made it pain free for the most part.  A little pain is to be expected.

And ken thank you for taking the time to explain to me a few things i was unsure about.

P&K

[Ken Shelmerdine]

And ken thank you for taking the time to explain to me a few things i was unsure about.

P&K

P&K You're more than welcome

[Restorer]

After my first catheter placement, I had fentanyl when I woke up, and a prescription for darvocet. I took the darvocet for 3 or 4 days afterward, but it was barely enough and made me dizzy and nauseous. A month and a half later, when my catheter refused to work, I went in for laparoscopy to see about untangling/unclogging it - during the procedure, they decided it would be easier to completely replace the catheter, so they went in through the same mostly-healed incision line and replace the catheter through the same exit site.

That time, I got something when I woke up, either fentanyl or morphine. When I got up to my room in the hospital, they tried to give me more morphine, but the combination of it and the anesthesia made me sick. After a little while they tried again with some oxycodone, but I was still unsettled from before and swallowing the bitter pill made me vomit immediately. They wouldn't give me anything else until that night when they tried oxycodone again, which I kept down. From that point on, and with a prescription after I was released the next day, I took oxycodone, and needed it for 4 or 5 days.

[mikey07840]

Sorry I can't be of much help here. I am mostly numb in the area that the catheter was placed. (Left over from the radical nephrectomy. My scar from that is about 15 inches in a big V.) My only advice to everyone is that there is no need to be in pain. There are plenty of medicines for pain and your doctors should provide them upon request.

Good luck with everything.