Pain management post open heart surgery? - page 2

by twinkletoes53

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A very close relative had open heart surgery for an aortic valve replacement 2 days ago. She is 84 years old. She was extubated late the same day, and is now in the cardiac step down unit @ her hospital. According to her sister,... Read More


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    Percocet 1-2 q3 or 4h is typical. Fresh hearts have a morphine PCA for the first 24 hours, but it is dc'd once they leave ICU. Toradol is rare because of renal concerns. Elderly folks will get plain tylenol and/or Tramadol. Once their chest tubes are out, they often don't want anything at all. Usually younger pts have a great deal of pain with chest tubes, and they make get scheduled tylenol q4h and oxcodone 10-15 mg q3-4 hr. Very rarely, they may get IV narcotics if their pain is out of control.
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    For 2 days post-op usually Vicodin 5-7.5/ 500 (1-2) or Percocet 1-2 every 4-6 is usually sufficient. May use Dilaudid 1-2 mg IVP q 2 prn for severe breakthrough pain if allergic to Morphine . Toradol 30 mg IVP every 6 helps quite a bit, just watch for bleeding. I agree the pain will be MUCH better after the chest tubes are out (they hurt like hell). Need to have her sit up in a chair at least TID. Need to ambulate at least QID starting the day before the chest tubes plan to be removed and every day after that. Zofran or Phenergan help control the nausea from the pain meds and Senokot S is vital while on pain meds to prevent constipation !!!! Hope this helps !!! God Bless !!!!

    Sent from Bruce M. Pomeroy, MSN, RN
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    I've worked in a very large open heart recovery unit for decades. We use morphine/fentanyl/dilaudid for about 48hours, giving it as often as every ten to twenty minutes with max limits. Day two, we add vicodin/percocet every four hours. We use Toradol as well, either as drip or intermittent dose if patents kidneys are healthy and they are not bleeding.
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    Our standard pain management orders for post-open heart surgery patients are Tylenol 650mg q4 po prn, oxycodone 5-10mg q4 po prn, and dilaudid 0.2mg iv q2 hours prn (may repeat dose once within two hours of first dose).

    This typically works well. I find that giving the Tylenol/oxycodone together every 4 hours keeps the pain well under control. The dilaudid seems to take the edge off if they have breakthrough pain. The dilaudid dose is increased depending on patient response, but usually never higher than 0.5mg q2.

    Toradol IV is used for those with good kidney function if their pain isn't managed well with the standard regimen.

    It sounds like she is progressing well from a cardiopulmonary rehab perspective, but could use more aggressive pain management! Patients typically feel much better upon removal of their chest tubes...especially the left pleural one. It seems like the major complaints of pain from my patients aren't concerning the sternotomy, but the pleural chest tube site, or if their SVG can't be harvested endoscopically and they end up with a significant leg incision. The younger the patient, the more the sternotomy seems to hurt.
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    An awful lot of elderly folks are very hesitant to take narcotic pain meds even when their nurse is STRONGLY encouraging them to take it! *Ahem* We are very agressive with pain management post CABG. IVP fentanyl, PO Perc alt with oxy's so the pt can have something Q 2H and more PRN for coughing of activity.

    TCV nurses know that the patients will be in a LOT of pain, and that they will have to make the patients do stuff that hurts. We do a lot of educating that it is OK to take the pain meds.

    Wishing her a speedy recovery!
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    hi....im nurse frm india...in our hospital...whn we receive CABG patients..we start fenta sedatin infusion till xmg mrng 4am..thn at 6am.we give T piece trial...thn round the clock analgesic is started...which is tapered...made sos thn..stppd...
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    I work in a pedi CICU, typically once extubated we will use PR tylenol/morphine/toradol until PO feeding then start on oxycodone. If they are older and we want them getting up and out of bed we might have pain team start them on a PCA either with a low basal rate with on demand dosing or on demand dosing only.
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    With the elderly it is about encouraging them to take medicine to promote pulmonary toilet. We must alleviate fears of dependence and addiction. I tell my patients if you cannot use your incentive spirometer than that is too much pain. We use Toradol for 24 -48 hours post-op or for as long as they have chest tubes. We vary our pain meds from Norco or percocet and add ultram prn. It really is about finding the right medication for the patient.
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    How frustrating to have a relative going through this and not receiving adequate pain control! It is SO important for post-op hearts to becomes extubated ASAP and ambulatory! As is pain control. Dilaudid is wonderful!!! As is morphine (but you said she has an allergy). I would think Lortab or Percocet would be ordered PO with the Dilaudid as her IV med for "severe pain".
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