Noyac

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Anyone using dilaudid in their spinals? I did one so far and the results were pretty impressive. Less pruritis and greater pain control. Yes Jet, less pruritis. I was impressed with the first go around. It was a total hip and the pt was a chronic pain pt with multiple medical problems. She didn't touch her PCA that night and hit it twice before I saw her the next day at 1pm. She was not nearly as impressed as the surgeon who thought she was going to be a pain nightmare.
 

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Noyac said:
Anyone using dilaudid in their spinals? I did one so far and the results were pretty impressive. Less pruritis and greater pain control. Yes Jet, less pruritis. I was impressed with the first go around. It was a total hip and the pt was a chronic pain pt with multiple medical problems. She didn't touch her PCA that night and hit it twice before I saw her the next day at 1pm. She was not nearly as impressed as the surgeon who thought she was going to be a pain nightmare.
Have used it a few times with the same kind of success. Don't have the opportunity to use it much lately as I'm doing more cardiac and neuro than thoracic or ortho lately.
 
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nimbus

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it's my opioid of choice for postop cle and cte's. How much for spinal? like 0.1mg?

thanks
 
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Noyac

Noyac

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nimbus said:
it's my opioid of choice for postop cle and cte's. How much for spinal? like 0.1mg?

thanks

I used 0.2 mg. and make sure its preservative free.
 

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Noyac said:
Anyone using dilaudid in their spinals? I did one so far and the results were pretty impressive. Less pruritis and greater pain control. Yes Jet, less pruritis. I was impressed with the first go around. It was a total hip and the pt was a chronic pain pt with multiple medical problems. She didn't touch her PCA that night and hit it twice before I saw her the next day at 1pm. She was not nearly as impressed as the surgeon who thought she was going to be a pain nightmare.
Very, very cool, Noy!!!!!

I'm gonna try it!!

Thanks for the cool tip.
 

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Noyac said:
Anyone using dilaudid in their spinals? I did one so far and the results were pretty impressive. Less pruritis and greater pain control. Yes Jet, less pruritis. I was impressed with the first go around. It was a total hip and the pt was a chronic pain pt with multiple medical problems. She didn't touch her PCA that night and hit it twice before I saw her the next day at 1pm. She was not nearly as impressed as the surgeon who thought she was going to be a pain nightmare.

Whatcha think about C section spinals? .2 as well?
 
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Noyac

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jetproppilot said:
Whatcha think about C section spinals? .2 as well?

Sure but I have only done it for a total hip so far and the duramorph is really working well (for me) in the c/s. So I'll probably keep with the duramorph. I don't feel like the c/s are as painful and I have to go to the pixis for the dilaudid. Can you imagine that? What a waste of time. :smuggrin:
 

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Noyac said:
Sure but I have only done it for a total hip so far and the duramorph is really working well (for me) in the c/s. So I'll probably keep with the duramorph. I don't feel like the c/s are as painful and I have to go to the pixis for the dilaudid. Can you imagine that? What a waste of time. :smuggrin:
Sorry - just curious from another thread (a bit of a hijak). Why don't you sign out all your narcs every mornng from pyxis - the ones we don't already provide you? When you're done, you just get a cosigner to sign wastage - one of he rns or put it in a sealable bag if you don't want that and return it to pyxis.

Pyxis should make life easier - not harder. I'd be curious to know why it's a waste of time (I took that to mean more difficult).

Its a definite time consuming process on our end, but pyxis has made that a bit easier. However, our ease should not come at the cost of ready availbility of drugs....so - I'm interested in your input. Your thoughts would be appreciated (knowing...we cannot go back to the era of the drug room which had everything from the old bottle of ether to the streptomycin which expired in 1971! ;) )
 

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sdn1977 said:
Sorry - just curious from another thread (a bit of a hijak). Why don't you sign out all your narcs every mornng from pyxis - the ones we don't already provide you? When you're done, you just get a cosigner to sign wastage - one of he rns or put it in a sealable bag if you don't want that and return it to pyxis.

Pyxis should make life easier - not harder. I'd be curious to know why it's a waste of time (I took that to mean more difficult).

Its a definite time consuming process on our end, but pyxis has made that a bit easier. However, our ease should not come at the cost of ready availbility of drugs....so - I'm interested in your input. Your thoughts would be appreciated (knowing...we cannot go back to the era of the drug room which had everything from the old bottle of ether to the streptomycin which expired in 1971! ;) )
From my experience in various hospitals, a pyxis system is time consuming if it is in one location only in the OR (in which case you are likely to be competing with other people to access it) or if it is a pyxis for everyone to get their drugs and possibly certain surgical materials (the dreaded integrated pyxis). I love the system in place at Baylor Plano Medical Center, wherein each OR has its own pyxis strictly for drugs and fluids only (no lap sponges, braces, etc.). Anything I want is available including every type of narcotic and paralytic, except cisatracurium/Nimbex. The pharmacist says it needs to stay refrigerated, so it stays in a central refrigerated pyxis, yet succinylcholine is also supposed to be refrigerated, but is readily available in the OR pyxis. However, since sux is used very frequently and Nimbex use depends on the provider, I can see why this is done.
 

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sdn1977 said:
Sorry - just curious from another thread (a bit of a hijak). Why don't you sign out all your narcs every mornng from pyxis - the ones we don't already provide you? When you're done, you just get a cosigner to sign wastage - one of he rns or put it in a sealable bag if you don't want that and return it to pyxis.
For us, frequently the schedule changes during the day.
 

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militarymd said:
For us, frequently the schedule changes during the day.
Thats a big issue for us too....so narcs are signed out in the AM for 7-expected cases...one cancels, two are moved to other rooms for efficiency reasons, etc.
 

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UTSouthwestern said:
From my experience in various hospitals, a pyxis system is time consuming if it is in one location only in the OR (in which case you are likely to be competing with other people to access it) or if it is a pyxis for everyone to get their drugs and possibly certain surgical materials (the dreaded integrated pyxis). I love the system in place at Baylor Plano Medical Center, wherein each OR has its own pyxis strictly for drugs and fluids only (no lap sponges, braces, etc.). Anything I want is available including every type of narcotic and paralytic, except cisatracurium/Nimbex. The pharmacist says it needs to stay refrigerated, so it stays in a central refrigerated pyxis, yet succinylcholine is also supposed to be refrigerated, but is readily available in the OR pyxis. However, since sux is used very frequently and Nimbex use depends on the provider, I can see why this is done.
Just a quick sidetrack... Do most teaching hospitals make use of pyxis? I think when it comes to narcs it is quite helpful covering yourself because of all of the DEA regulations.
 

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Born2baDoctor said:
Just a quick sidetrack... Do most teaching hospitals make use of pyxis? I think when it comes to narcs it is quite helpful covering yourself because of all of the DEA regulations.
Parkland started using them when I was leaving, however, I have no clue about other teaching institutions.
 

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we have a pyxis in each of our OR rooms, the most used narcs and other drugs are in it, but if you're using something less ordinary, you have to go to the pharmacy and check it out with them. They've made it somewhat customized in that duramorph is only available in the csection rooms, precedex and remifentanyl tend to be in the neuro rooms only. Nobody liked the transition to pyxis ~1 year ago, but now I think it's much better than the old narc box.
 

sdn1977

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Thanks for all your replies on pyxis. Its good to know how its used in other places & how its received by the users. I appreciate the input!

Yes...most teaching institutions have them now. It is a way to track users which change much more frequently there than in any other facility.
 

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Both, but beware. It will drop their BP even without the LA.
ok - i'll try it next time. so if i usually do a THR or TKR with 2cc of .75% marcaine, should i cut back the dose of marcaine to allow for room of the 0.2mg dilaudid. it's been forever since i've given dilaudid IV so i don't remember the conc (1mg/cc?)
 
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Noyac

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ok - i'll try it next time. so if i usually do a THR or TKR with 2cc of .75% marcaine, should i cut back the dose of marcaine to allow for room of the 0.2mg dilaudid. it's been forever since i've given dilaudid IV so i don't remember the conc (1mg/cc?)
Yes, its 1mg/cc.
be sure it is preservative free, as if I have to tell you that.
I usually put about 8mg bupiv in with it and put them to sleep. Slow surgeons!
i would suggest doing it without any local first and put them to sleep. Then try adding some local. Have some neo on hand as well.
If you don't put any of these cases to sleep then go with the 8-12mg bupiv mixture and a good supply of neo.

Oh, and let me know after you use it, what you think. I started it about a month ago with another partner of mine and the results were great. Then we ran out of the PF Dilaudid. Still waiting for more. The surgeons were impressed to say the least.
 

jetproppilot

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Yes, its 1mg/cc.
be sure it is preservative free, as if I have to tell you that.
I usually put about 8mg bupiv in with it and put them to sleep. Slow surgeons!
i would suggest doing it without any local first and put them to sleep. Then try adding some local. Have some neo on hand as well.
If you don't put any of these cases to sleep then go with the 8-12mg bupiv mixture and a good supply of neo.

Oh, and let me know after you use it, what you think. I started it about a month ago with another partner of mine and the results were great. Then we ran out of the PF Dilaudid. Still waiting for more. The surgeons were impressed to say the least.
Yep. Noy.

Anesthesia rokkstar. :thumbup:
 
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