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Forum Name: Gastroenterology Topics

Question: spinal block for colonoscopy?


 TheTeach - Wed Jul 22, 2009 1:47 am

I am a 66 year old female who has yet to have a successful scope -- "tortuous" "redundant" "spastic" "post-C-section" etc.. With the usual meds (midazolam and opiate) there was awful break-through pain, vomiting and combativeness. As I have apnea, I don't want diprivan. I did try the CT colonography, which was totally comfortable but due to an incompetent ileocecal valve the visualization was "suboptimal" (Is this radiology-speak for "pretty p***-poor?), and a repeat was advised. Another complete waste of time, money and "ordeal by prep". As my sister and aunt had polyps at a younger age than I (though no family CA history) I really would feel more peace of mind if I could try again, and my M.D. thinks so, too. Since I had several gyn surgeries with spinal blocks, and so never needed opiates or sedatives, could this be the way to go for a colonoscopy? How do I find a doctor who does this? (I've interviewed several GEs, however none care to vary in the least from their SOPs!) If only I could find a GE who'd at least consider it or provide some other creative alternative. I live in the SF Bay Area, so you'd think I could find someone who'd at least be willing to discuss options. Any ideas out there?
 Dr.M.Aroon kamath - Sun Oct 04, 2009 9:01 pm

User avatar Hi,
I personally will not advise that and i doubt if any gastro-enterologist would agree to your proposition. Howvever, i am sure most of them would give you a patient hearing.
 TheTeach - Wed Oct 14, 2009 12:00 am

Well, the doctor's reply was helpful in that it gave me the poor odds on a doctor doing an epidural for colonoscopy. However, is there advice for what method of analgesia can be used, without sedation? Can Fentanyl alone be used? I know that the midazolam is supposed to potentiate the Fentanyl, but given my (familial) paradoxial reaction to the benzodiazepine family I definitely decline Versed. I still need to get a baseline colonoscopy done, and as it is "technically difficult" according to the previous report of the incomplete one, what is suggested? I need a constructive suggestion that fits within my parameters, please.
 Camille Stubbs, RN - Thu Oct 15, 2009 5:34 am

Hello TheTeach,

Well, I have never read, heard or seen a spinal block used for a colonoscopy procedure. I am not sure you will have any luck with finding a physician that will do this for a colonoscopy. Spinal blocks are associated with surgery, and a colonoscopy is not a surgery but a procedure. Medications used for surgeries are usually different than medications used for procedures. Medications used for a colonoscopy cause conscious sedation(patient can still respond to verbal and physical stimuli maintaining an unassisted airway). Spinal blocks are just not used in this manner.

Secondly, discuss with the Gastroenterologist your concerns/issues and he/she can devise a tailored plan of care/plan of action for you. Based on my medical experience, fentanyl and versed medications are used. If I understand you, you stated there is familial history of problems with versed; you didn't have the problem yourself? Familial history issues are problems/conditions/diseases you can possibly experience; does give the physician a guideline. In consideration of your familial history, perhaps the physician can combine the fentanyl with another medication.

Thirdly, remember physicians are governed by guidelines according to the medical board and law. They can not perform surgeries and/or procedures that just are not standard.

Good Luck
 Dr.M.Aroon kamath - Thu Oct 15, 2009 7:02 am

User avatar Hello Camille,
Thank you so much for your reply. I hope your reply will go some way in persuading or guest, TheTeach.

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