Lumbar pain after bariatric surgery

[Sleeplessbordernights]

So this happened to me last week.
I’m on call, In a trauma surgery. Im calles to the PACU as a pt is complaining of pain, screaming actually

I arrive and see this huge guy, 6 3 ft, 380 lbs, who just got a gastric bypass done an hour ago, screaming everytime he moves, his vitals are normal considering the pain he is in. However he refers no pain at all in his abdomen, he refers a 10/10 lumbar pain in radiating to the left leg, my attending was therem we perfomr just bragard and lasague which are both positive. After some toradol and steroids the pain starts to go down.

My theory is the pt moved while the surgery and his lumbar spine got stuck in a “bump” in the operating table and nobody noticed. I have never seen this tough, what do you think? The pt refers no prior back pain

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[Blockit]

Big heavy guy like this, lying paralyzed on an operating table for an abdominal operation like that has his spine relax into positions it probably doesn’t normally relax in to.
Add to that an easily agitated personality and it’s the perfect recipe for what you saw in the PACU.

 

[Sleeplessbordernights]

Big heavy guy like this, lying paralyzed on an operating table for an abdominal operation like that has his spine relax into positions it probably doesn’t normally relax in to.
Add to that an easily agitated personality and it’s the perfect recipe for what you saw in the PACU.

I figured that, however I have never seen it, I was afraid I was missing something mote dangerous

 

[deleted875186]

Did probably had a or existing disc bulge or herniation, maybe had minor back pain before, and positioning maybe triggered some radiculopathy.

Tylenol, NSAID, muscle relaxant, if ok by surgery than a 5 day pulse of steroid. Could trial some lumbar traction with PT while in house.

If he’s staying 1-2 nights for the gastric sleeve, I would just order him a lumbar MRI while in house to CYA since the timing is unfortunate, but probably a disc herniation he will simply recover from.

 

[vector2]

So this happened to me last week.
I’m on call, In a trauma surgery. Im calles to the PACU as a pt is complaining of pain, screaming actually

I arrive and see this huge guy, 6 3 ft, 380 lbs, who just got a gastric bypass done an hour ago, screaming everytime he moves, his vitals are normal considering the pain he is in. However he refers no pain at all in his abdomen, he refers a 10/10 lumbar pain in radiating to the left leg, my attending was therem we perfomr just bragard and lasague which are both positive. After some toradol and steroids the pain starts to go down.

My theory is the pt moved while the surgery and his lumbar spine got stuck in a “bump” in the operating table and nobody noticed. I have never seen this tough, what do you think? The pt refers no prior back pain

Ive noticed a very high percentage of bariatric pts request pillows or propping under their knees after being positioned supine, likely cause they have exaggerated lordosis. Wonder if not having his lumbar spine flat against the table (fat roll distortion, no hip flexion, no under knee support) contributed.

 

[Beeftenderloin]

A lumbar MRI on this individual (and virtually anyone else presenting for bariatric surgery) will without question show varying degrees of degenerative disk disease, maybe even a couple really ugly looking herniated disks. Whether or not that’s actually the source of their pain is another story.

 

[deleted875186]

A lumbar MRI on this individual (and virtually anyone else presenting for bariatric surgery) will without question show varying degrees of degenerative disk disease, maybe even a couple really ugly looking herniated disks. Whether or not that’s actually the source of their pain is another story.

Degenerative disc? We’re talking about a herniation with classic symptoms as noted above, the OP should tell us what dermatome the pain in the leg follows, MRI the lumbar spine, and see if it correlates, if there’s a big formainal extrusion at L5-S1 with pain shooting to the top of the foot than it’s a slam dunk.

 

[surgndoc]

Large amount of reverse-T for these patients may mean they’re essentially standing for longer than they ever normally would. There is usually a perpendicular piece placed on the foot of the bed so they don’t slide downwards.

Had a pt several years ago screaming with severe bilateral ankle pain after a gastric bypass where the pt was in steep reverse-T for several hours.