Tuesday, May 25, 2004

pain management

An epidural was used during surgery to numb sensation and to provide pain relief post op. Often, morphine drips are used to numb pain but the anaethetist decided an epidural would be better. This wouldn't cloud Ethan neurologically but would block pain from the wound site down. The epidural needs to be monitored so that the block level doesn't travel up the spine and effect the lungs and heart, not an easy thing to test for in a 2 year old who cannot talk! This is partly why the epidural was turned down after his bradycardia episode last night. This morning, the Pain Management Team reviewed this level and said he was doing OK. During the course of the day, he became very stiff and was in obvious pain. Reviews by the Kidney Team, Cardiology Team and the Physio confirmed our thoughts. Pain Management was subsequently called for another review. They decided he was uncomfortable due to another cause and the epidural was actually reduced. As the day went on, Ethan became even less active, couldn't clear his throat and started groaning. We pushed for another review, he was in obvious pain. The PMT (including operation day anaethetist) decided this time he was in pain. A bolus was given and the rate increased. This had an immediate effect, Ethan clapped the anaethetist on the way out of the room. He was a lot more comfortable when we left.

Other concerns during the day were about fluid balance. This is hard to achieve due to having one kidney and an underlying cardiac problem. Too much fluid can stress the heart, but is needed to flush the kidney. A chest xray was ordered to check for infection and some blood was taken to pathology also.

We haven't received the results from the lab yet regarding the exact nature of the tumor, should know tomorrow.

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