Under the Covers: My Experience With Post-op Pain Control - page 3

As nurses, we are used to being in control. We help manage our patient’s medications, their diet, and activity. No matter where nurses work, we have to organize our day in order to get everything... Read More

  1. by   Brenda F. Johnson
    Quote from LovingLife123
    I'm a month out from major surgery. I had a block given to me for the first time. I kept telling the nurse in PACU I had no pain. Then on my way to my room, the block wore off and the pain was excruciating. It wore off all of the sudden, not gradual like my mind thought. I was in tears when we got to the floor. The PACU nurse felt awful and I felt bad for her, and I kept reassuring my floor nurse it was not her fault...... I will tell you, I was asking for my narcs q4h because I did not want to be in that pain again. It took 2 doses to get it under control. So that took about 6 hrs or so.

    My nurses were great, but I felt like maybe they thought I was a clock watching addict because I was clock watching. Just because I didn't want to be in pain again. Every single one was awesome, but I was scared of what was being said at the nursing station. Were eyes rolling? Was I a pain? I never wanted to be that.

    Being on the patient side can change your view. My recent surgery was not the first time I have been a patient, but it's always a reminder that I need more compassion. And I'm a huge advocate that you don't ever undertreat pain. But I've been reminded there is more I can do.
    Ouch! I'm surprised the block wore off like that, it must have been miserable! Anyone post op should not be deemed a drug seeker, it's a shame
  2. by   Brenda F. Johnson
    Quote from HeySis
    I work in PACU and am so sorry you had a poor experience in your phase 2 of recovery. I know many patients don't remember PACU, even the ones that have been chatting with me. I love when family is there when I take them into phase 2 and I can give the families a mini report of the things that I've been doing.

    I agree that dosing off is not an indicator there is no pain, I have many times used a pain scale for unconscious patients (FLACC or CPOT) to assess and start treating pain before a patient wakes up or can verbalize they are hurting.

    But I also have many patients that dose off and "forget" to breathe, and when I stimulate them (verbal or sometimes a light sternal rub) to get them to breathe... they are crying in pain again. In these cases, I explain (over and over) that while I realize they are experiencing pain their body cannot handle any more opioids. If I have to choose pain relief or breathing, I chose breathing every time.

    There is where multimodal pain relief is so important. Some of our surgeons are now giving Celebrex, Lyrica, Tylenol and oxycodone p.o. pre-operatively. Our anesthesiologists give IV toradol and lidocaine. With the exception of the oxy, none of these medications cause respiratory depression, but they work on nerves and pain in different ways, and together can help decrease the amount of opioids needed to get pain under control. And then there are non-pharmalogical interventions (elevation, positioning, cold/heat, splinting....) There are also regional anesthesia pumps that release an analgesic med like bupivocaine through a catheter for several days into the surgical site (On-Q's are one type).

    In cases where a patient is having pain, but I have done all I can with non-opiod/non-pharmalogical and they are too somnolent to get more IV meds, I will discharge onto the next phase if they met the other criteria. Sometimes oral meds work better and last longer then the IV stuff... with less respitory depression. Sometimes they need to give the meds a chance to catch up (I can admin fentanyl every 5 mins and dilaudid every 10m). Often pt pain will go down within minutes of receiving these medications, but they don't peak for hours... and if I give too much they can all peak at the same time. So we do have to be mindful, no-one wants to have to administer narcan, especially a patient who is then left in excruciating pain. Sometimes (with laparoscopic surgeries especially) they need to get up and start moving for the pain to come down.

    We need to educate ourselves and others, to ask for multimodal pain relief... to use the Tylenol and NSAIDs around the clock (just like we give our kids when they are teething) and supplement with opioids... which means we need to ask (for ourselves and our patents) Dr's for narcotics that don't have the Tylenol/or NSAIDS in them so we don't overdose on those.

    My beef is not with giving patients pain medications, it's with surgeons that tell their patients that it's an easy surgery and the patient wakes up wondering why they hurt... DUH, someone just sliced you open, of course that's going to hurt!!! And it makes me sad to know that I may have a patient that thinks I did nothing for their pain... because they don't remember that I treated it, until I needed to hold and wait for things to wear off so they would spontaneously breathe with out prompting.

    I am certainly not saying this is your case OP, and in your case I would ask for a referral to a pain specialist before you develop chronic pain... there is a lot they can do with nerve blocks, ON-Q catheters and physical therapy to get rid of the pain... the sooner you start the better off you will be.
    You make some excellent points, and gave us some great information! Thank you
  3. by   Brenda F. Johnson
    Quote from gracie65
    I had minor surgery a year ago, and was offered 1-Norco 5/325 or a Motrin after I woke up from anesthesia for a pain rating of an "8." Seriously? I think with all of the recent concern over opioid overuse and abuse, pain control has become less of a "necessity" and almost like an unwelcome burden to the provider and facility. Our facility can't seem to get it together for a cohesive pain management protocol. We are told to only give pain meds if the patient is experiencing pain, and it had better be above a "6" for any narcotics. However, you can about guess when a surgery block is about ready to wear off, and I like to give my patients "preventitive" pain meds about an hour or two before, but because they're rating their pain at about a "2 or 3", by protocol, I shouldn't be giving anything more than Tylenol, and then BOOM! An hour later they are wincing and telling me their pain is a 6 or above. Just because the nation is in an opioid crisis doesn't mean that post-surgical pain just magically disappeared and that opioids and narcotics aren't proper ways to treat it! There needs to be thoughtful, reasonable discussion about how to treat people's pain without going overboard, but also being realistic. After ortho surgery, and being stuck on a table with saws, files, etc. being used to do your surgery, you're going to hurt like hell without any pain meds. Giving someone oxycontin would be appropriate. If they're STILL needing Oxy 3 weeks post-op, then something is terribly wrong, and THEN needs to be addressed but not post-op. This is one of the most frustrating parts of my job.
    Wow, the problem with that knee jerk reaction to opiod overuse is not valid. Post op people should not be even counted in that group, right?
  4. by   Brenda F. Johnson
    Quote from lindahartford
    I am a retired nurse with 53 years of experience in med-surg and psychiatry.

    Recently, I had surgery that required sedation and anesthesia. I am always astrongly affected by sedation and actually remember very little of my first 2 post-op days. I was encouraged to take pain medications although I was so sedated I didn't feel pain.

    What disturbs me the most, even now, is that I was discharged although I had no idea what my follow-up care should be. I kept saying I wasn't ready to go home but everyone, nurses, physical and occupational therapists, and even the doctor who assisted with my surgery said I was and I was discharged accordingly. If my head had been clear I would have demanded to see a social worker, a case manager, and my surgeon. As I was, I just followed directions and home I went.

    I had no idea what to do with my leg brace or ice pack machine. Simple things and perhaps I was instructed in them but my mind was so fuzzy I couldn't remember. It is like the nurse who came in and was sarcastic about your pain button next to your bed. How did he not know that we all need to be reinstructed in every aspect of care til we can repeat and/or demonstrate it back clearly?

    I'm not sure that is because we nurses are so busy, as we are not instructed ourselves in the effects of anesthesia on our minds. I worked in Home Health for 30 years, and one of the things all of my team knew was that reality and time orientation were needed for days and sometimes weeks for any older person who had anesthesia.

    Surgery is not just a physical experience, it is mental, emotional, and spiritual as well.
    I think your experience is all too common. So sorry this happened to you!
  5. by   Brenda F. Johnson
    Quote from MelissaBarthold
    Wow -- don't get me started.
    And --- I promise: I couldn't make this up.

    When I had a posterior fusion - after a week in the hospital pre-op on IV fentanyl for intractable pain and 13 hours in the OR - I was in surgical ICU. I got one dose of IV fentanyl. The nurse 'caring for me' decided I was drug-seeking (based on who knows what - I didn't know her, she'd never met me), so she got my pain pump order canceled and the pain relief order she asked the intensivist for was a fraction of the dose I'd been on preop: 1 mg fentanyl every 2 hours prn.

    And....just to make everything great: she took away my call light and closed the sliding glass door to my cubicle.

    I promise - I couldn't make this up.

    No surprise -- I ended up with PTSS. All I could remember was seeing the glare of the fluorescent lights....and that I kept asking for help.....that never came until the next morning. That was a very long night........horribly long.
    OMG! I am so sorry. Pathetic. Thank you for sharing your story.
  6. by   Karrony
    Thank you for the article. I hope you have recovered since your surgery and doing well. Your article was a nice insight to how some places handle post-op care. It's unfortunate you had to go through that, but from reading these experiences, I hope to never neglect pain by repeating those mistakes you wrote about.

    I've also experienced surgery before. In 2015 I had brain surgery and oddly enough, as much as the nursing staff tried to control my pain, I was actually the one hindering their efforts. I had a thought in my head that I didn't want to bother the staff, as they had sicker patients. Haha. I kept denying the opiate pain drugs, relied on the 1g acetaminophen round the clock, an ice pack, and never pressed my call bell. All this with the most excruciating pain I've ever felt in my life!
    I have a feeling that deep down, the nursing staff knew what I was up to, and they always made an effort to see me q hour to see how I was doing. I only now realized that, by trying to create less work for the nurses, I actually increased it!
    So whenever I have a patient who may be "covering up" pain, or brushing it off, I always make sure to have a chat with them, and tell them that if there's ANYTHING I can do for them, I'm there. Don't feel bad about pressing that call bell! I learnt my lesson, and don't want patients repeating my mistake!
    Last edit by Karrony on Oct 6 : Reason: formatting
  7. by   Munch
    My post-op pain control was a complete mess. I had a craniotomy that was supposed to be 4 hours turn into an 8 hour surgery due to some complications. I had a PCA ordered but it hasn't been set up by the time I got to the PACU so as I was waiting for that to be setup I was given IV injections of dilaudid....0.2mgs. It was seriously a joke and my nurse(who knew I was a nurse as I worked at that hospital) was just completely baffled as to why it wasn't working..0.2mgs of dilaudid might work for peds. I told her that dose wasn't sufficient even for someone who just didn't have their skull sawed open. So by the time the PCA was set up it just wasn't working. I was pressing the button whenever possible but as everyone knows once that fraight-train takes off catching it is almost impossible. Pain management had to come up and increase my bolus dose to 0.4mg q8mins and they had to order a clinician dose of 2mg q2hrs and ordered ativan not only to calm me down(I was incredibly restless) but it also helped the muscle spasms in my neck(the incision was behind my right ear and went close to my jaw, so the position of my head in the OR did a number on my neck. I am happy that my pain was finally under control but it took a lot of tears before that happened. If they simply started with a higher dose of dilaudid things may have gone better..maybe not, but 0.2mgs of dilaudid??? Really? I know in the ER for an acute injury for the opiate-naive they start with at least 1mgs..sometimes 2.

    Now don't even get me started on the fact that I was in the PACU for over 24 hours waiting for a neuro ICU bed and they gave me benadryl and Ambien to help me sleep(along with the ativan and lets not forget my dilaudid PCA I had) so I obviously was out like a light and would wake up in pain..on an uncomfortable stretcher all tangled in my IV lines/wires. My PCA button fell out of my reach and was in the big Gordian knot of IV lines and at this point my head was pretty much glued to the pillow because it hurt to move even slightly..bless the CNAs heart who helped me and tied it to the railing for me. Looking back on it I can laugh now because its just so me..but I can assure you I was not laughing at the time it was like some cruel joke being in excruciating pain and having the answer to your problems literally at arms length.
    Last edit by Munch on Oct 7 : Reason: Spelling
  8. by   Kooky Korky
    Quote from traumaRUs
    Thanks so much for this article.

    I recently had major surgery and had excellent pain control. That said, pain is very subjective. I've talked to multiple people who have had surgery similar to mine and they complained that they had horrific pain for weeks afterwards. I was actually back to work 8 days later. So...pain is very much what the patient says it is. Its not OUR interpretation of what the patient SHOULD experience. Its very individual
    Any more, it's what Congress says it is.
  9. by   Kooky Korky
    Quote from Neats
    My son was injured in Iraq and eventually received OAT surgery for an area on his foot. We were all there when he woke up...in pain. He did have a PCA and as he started to wake up (took him about half hour) I was pushing that PCA every chance I could get. The staff told me to eave it alone and if he was in pain he would tell them. When he woke up, he was crying in pain. It took the nurse 20 mins to just come into his room, no apology, no nothing, just OK what do you want. She wanted him to try his PCA before she gave him the big stuff.

    I went to track down a physician and they did give him a shot...this was about 45 mins from the time he woke up to the time he got his shot. No one cared about his pain at all but me...his mom...a nurse. He was released 5 days later and on the day of release he had a heavy therapy session. They gave him no pain pills...nothing. All I had was naproxen at home. I have dear friends who could prescribe and they did just that for my son. This was a VA hospital. When my son went back for his check up a week later someone had tagged his chart that he was drug seeking. Well at the time HE WAS, he was in pain seeking for pain medication. He has never asked for pain medication since even going through PT for weeks he just took some NSAID prior to therapy. I instructed him to get the record amended, went to QA at the hospital and they finally took that out of my sons records. Today he continues with the National Guard and is a mechanical engineer. I will never understand why people do what they do.
    It's a "monkey see, monkey do" type thing.

    It's ignorance (yes, doctors, nurses, therapists, etc. can be ignorant.)

    It's lack of personally having experienced what your son or others patients are going through.

    It can be due to cruelty - intentionally causing or not relieving pain. Warped people do go into our field sometimes. Terrifying thought.

    It can be due to being overworked, due to being distracted by one's personal issues at work or outside of work, it can be due to a true emergency taking the nurse away from the patient.

    It's probably due mostly to having been told that anyone asking for pain meds is drug seeking. I had a terminally ill CA pt who we mostly kept snowed. The nurse relieving me questioned whether she should give the morphine, as she felt the pt was drug seeking. I told her that the woman was just hours from death, what difference did addiction make at that point, give the morphine, have mercy on her. Pt died about a day later.

    I am so glad you had your son get his record amended. He should get a copy of it and check their files every so often to see that they haven't altered it again. And so grateful to him for all that he has done and continues to do for our country, and so glad that you were able to be at your son's bedside.

    God bless.

    For all posters who have had awful care, rude and ignorant nurses - these cases need to be made known to the nurses who did these things to you so they never happen to anyone else. If the nurses won't listen, go to their bosses. For the sake of their future patients, please do not remain silent.
    Last edit by Kooky Korky on Oct 9
  10. by   Brenda F. Johnson
    Quote from Munch
    My post-op pain control was a complete mess. I had a craniotomy that was supposed to be 4 hours turn into an 8 hour surgery due to some complications. I had a PCA ordered but it hasn't been set up by the time I got to the PACU so as I was waiting for that to be setup I was given IV injections of dilaudid....0.2mgs. It was seriously a joke and my nurse(who knew I was a nurse as I worked at that hospital) was just completely baffled as to why it wasn't working..0.2mgs of dilaudid might work for peds. I told her that dose wasn't sufficient even for someone who just didn't have their skull sawed open. So by the time the PCA was set up it just wasn't working. I was pressing the button whenever possible but as everyone knows once that fraight-train takes off catching it is almost impossible. Pain management had to come up and increase my bolus dose to 0.4mg q8mins and they had to order a clinician dose of 2mg q2hrs and ordered ativan not only to calm me down(I was incredibly restless) but it also helped the muscle spasms in my neck(the incision was behind my right ear and went close to my jaw, so the position of my head in the OR did a number on my neck. I am happy that my pain was finally under control but it took a lot of tears before that happened. If they simply started with a higher dose of dilaudid things may have gone better..maybe not, but 0.2mgs of dilaudid??? Really? I know in the ER for an acute injury for the opiate-naive they start with at least 1mgs..sometimes 2.

    Now don't even get me started on the fact that I was in the PACU for over 24 hours waiting for a neuro ICU bed and they gave me benadryl and Ambien to help me sleep(along with the ativan and lets not forget my dilaudid PCA I had) so I obviously was out like a light and would wake up in pain..on an uncomfortable stretcher all tangled in my IV lines/wires. My PCA button fell out of my reach and was in the big Gordian knot of IV lines and at this point my head was pretty much glued to the pillow because it hurt to move even slightly..bless the CNAs heart who helped me and tied it to the railing for me. Looking back on it I can laugh now because its just so me..but I can assure you I was not laughing at the time it was like some cruel joke being in excruciating pain and having the answer to your problems literally at arms length.
    Bless your heart! I hope you have recovered fully. Thank you for sharing your story, so sorry it was such a failure to get your pain under control.
  11. by   Brenda F. Johnson
    Quote from Karrony
    Thank you for the article. I hope you have recovered since your surgery and doing well. Your article was a nice insight to how some places handle post-op care. It's unfortunate you had to go through that, but from reading these experiences, I hope to never neglect pain by repeating those mistakes you wrote about.

    I've also experienced surgery before. In 2015 I had brain surgery and oddly enough, as much as the nursing staff tried to control my pain, I was actually the one hindering their efforts. I had a thought in my head that I didn't want to bother the staff, as they had sicker patients. Haha. I kept denying the opiate pain drugs, relied on the 1g acetaminophen round the clock, an ice pack, and never pressed my call bell. All this with the most excruciating pain I've ever felt in my life!
    I have a feeling that deep down, the nursing staff knew what I was up to, and they always made an effort to see me q hour to see how I was doing. I only now realized that, by trying to create less work for the nurses, I actually increased it!
    So whenever I have a patient who may be "covering up" pain, or brushing it off, I always make sure to have a chat with them, and tell them that if there's ANYTHING I can do for them, I'm there. Don't feel bad about pressing that call bell! I learnt my lesson, and don't want patients repeating my mistake!
    I am recovering really well, now 6 weeks out, thank you! Thank you for your input. We as nurses often don't want to be a bother, but we have to take care of ourselves, right!?

close