Post-op pain! - page 2

Right after we wheel a mother from the OR - c/s with BTL - into recovery, the anesthesiologist deemed it necessary to immediately take out her epidural catheter "because of some sterility... Read More

  1. by   SmilingBluEyes
    I agree; I would rather see the epidural stay in for 12-24 hours for pain relief. Used to have an MDA that did this and it worked GREAT. Got the patient thru til she was ready for PO pain meds, usually first post op day. But, all our planned c/s are given SPINAL anesthetics and therefore, there is no way to maintain that. They do get Duramorph in the spinal and this often provides excellent pain control for about 12-24 hours. If a patient begins to feel even an inkling of pain, if she can take PO fluids/crackers, etc, I will start her on Percoset/Vicodin ASAP as well as give Toradol q6 hours. This seems to work very well for most patients.

    Pain is something we have to stay on top of. I tell my post op patients it's like a snowball going downhill, the further you go, the harder it is to turn it around. They know there will be some pain/discomfort post-op but they are told by me NEVER to let it get out of control so much that they are begging for meds. I also encourage REGULAR and ON THE CLOCK use of pain meds in the hospital course. They just do MUCH better this way and heal quicker.

    I guess having so much experience as a post op patient myself has made me much more aware of post op pain control for my patients, and I begin teaching them very early about post-op pain control and the safety/efficacy of regular pain med use. It's that important to me.
  2. by   SmilingBluEyes
    Quote from suzanneuthscsa
    I must confess that I really know nothing professional since I don't start nursing school until next week, but I have a personal experience that is related. When my first baby was born, I had emergency c/s and was put under general. Mind you; liver enzymes through the roof and platelets down to 20,000 (I bled alot) due to severe HELLP syndrome. It was because of the platelets that I was unable to receive an epidural. I can tell you that when I woke up I was in the most HORRIBLE pain anyone can imagine. My liver, my incision, my back (from kidney problems). They prescribed Nubain through a PCA pump. What happened next is truly a sin in my opinion. Several hours after I left recovery, they decided to let me rest. My entire family left to be with the baby (he was 1 lb and not expected to survive). Everyone thought that the nubain and anesthesia would make me sleep. WRONG! Apparently the Nubain has some type of container that has to be opened and mixed (or something like that) and the seal was no good when they put it into the PCA pump. As a result, my pain control was going onto the floor instead of into my arm. I could not reach my call button, and my room was kind of separated from the rest. I cried out for 2 hours until my doctor finally came in on rounds and discovered the problem. I believe by that point I had gone 5 hours from the time that the nubain was put in, and I was white, sweaty, and was bleeding profusely from biting my lips. OUCH! My doctor was FURIOUS :angryfire and I heard her yelling for a good 15 minutes. I know that the nurses were busy and that they were trying to let me rest, but seriously....I had nearly died the night before and they should have monitored me more closely especially since my entire family was at a different hospital with my critically ill baby. It sure is nice to hear when a nurse like you advocates for a patient and recognizes that pain is something that everyone has a right to be as pain-free as medically possible. So watch out for Nubain since nobody seemed at all surprised at this occurence, like it is completely normal for the floor to be anesthetized instead of the patient.
    There is so much wrong here, I don't know where to begin. So I won't. I will just say I am so sorry about your horrendous (and rather precarious) situation.
  3. by   suzanneuthscsa
    I have often wondered why they didn't move me to ICU myself. I live in San Antonio so it was not a small hospital. I was supposed to have been flown to a larger hospital where the baby actually went. I just went downhill too fast. I also think that the other reason is that I immediately started stabilizing after delivery. My BP went down, platelets started climbing, liver enzymes started falling. So maybe I wasn't that critical anymore. If you want a real shocker, I was released from the hospital about 36 hours post-op!!! This was not an ideal situation, but they wanted me to be able to see the baby in case he didn't make it. Looking back, this was the wrong decision because my pain was out of control, I was too weak, and too much of a bleed risk, but oh well!
    I am also sure that the drug was Nubain and it was some type of pump that I could push the button every 15 minutes. I believe I was given this because of the whole liver problem. As horrible as it was, I still went back there to have my second baby, but it was a little less complicated. I just had regular pre-eclampsia and I was at 32 wks instead of 24 and I was able to get the epidural. My epidural was removed immediately after my surgery, but just before they put something in that would last a couple of days. Can't remember what, but it made my nose and face itch like crazy for the entire two days. I actually peeled like i was sunburned. It did keep me pain free, but I am not sure it was worth it.
  4. by   jwk
    Quote from suzanneuthscsa
    I have often wondered why they didn't move me to ICU myself. I live in San Antonio so it was not a small hospital. I was supposed to have been flown to a larger hospital where the baby actually went. I just went downhill too fast. I also think that the other reason is that I immediately started stabilizing after delivery. My BP went down, platelets started climbing, liver enzymes started falling. So maybe I wasn't that critical anymore. If you want a real shocker, I was released from the hospital about 36 hours post-op!!! This was not an ideal situation, but they wanted me to be able to see the baby in case he didn't make it. Looking back, this was the wrong decision because my pain was out of control, I was too weak, and too much of a bleed risk, but oh well!
    I am also sure that the drug was Nubain and it was some type of pump that I could push the button every 15 minutes. I believe I was given this because of the whole liver problem. As horrible as it was, I still went back there to have my second baby, but it was a little less complicated. I just had regular pre-eclampsia and I was at 32 wks instead of 24 and I was able to get the epidural. My epidural was removed immediately after my surgery, but just before they put something in that would last a couple of days. Can't remember what, but it made my nose and face itch like crazy for the entire two days. I actually peeled like i was sunburned. It did keep me pain free, but I am not sure it was worth it.
    IMHO - less than ideal all around. Being released 36 hours postop from a C/S necessitated by HELLP syndrome? Did you sign out AMA or did they actually release you and let you go? That's truly shocking to me on several different levels.

    And why would you go back to the same facility for a 2nd C/S, premature, and pre-eclamptic, after the problems with the first pregnancy? You'd have been better off at a larger center (obviously there are some in San Antonio, right?) that could easily take care of you AND the baby if there was a problem with either of you.
  5. by   suzanneuthscsa
    Quote from jwk
    IMHO - less than ideal all around. Being released 36 hours postop from a C/S necessitated by HELLP syndrome? Did you sign out AMA or did they actually release you and let you go? That's truly shocking to me on several different levels.

    And why would you go back to the same facility for a 2nd C/S, premature, and pre-eclamptic, after the problems with the first pregnancy? You'd have been better off at a larger center (obviously there are some in San Antonio, right?) that could easily take care of you AND the baby if there was a problem with either of you.
    I did not leave AMA. Nor was I really enthused about leaving. I was very bitter at the time, and more than a little frightened of getting attached to a baby I was sure would die. (He was under a pound and he did make it!) They made me get up, walk the hall a few times, assisted me with a shower, and gave me strict instructions on bleeding risks like don't brush your teeth, don't wear a seatbelt, etc. They did try to release me and readmit at the hospital where my son was, but the insurance company would not go for that. It really was important for me to see my son, but I could have used another day of rest.
    I mainly went back because of my OB. She is really very wonderful, and it was mainly the fault of my nurse. My first baby had also spent the last 6 weeks of his hospital stay at this facility's NICU and I was very close to the staff. My second baby was big enough to stay at this facility so I chose to deliver her there. It was a very positive experience the second time around and I stayed 3-4 days after the second C-section which was the perfect amount of time. My son had spent six weeks at a larger facility in SA and I hated it. The nurses were rude for the most part, it was 30 miles further away from me, the parking fees were atrocious. He also grew better once he got to a much quieter and calmer environment. They have a Level III NICU at the smaller hospital, but they did not have the oscillating vent when my son was born which he needed. Does this make any sense, or do I seem like a total nut case? This is sounding bizarre even to myself! I admit to being a little terrified the second time, and I made sure that every nurse on the floor knew about the last experience and that I would not tolerate it again.
  6. by   RNnL&D
    Quote from suzanneuthscsa
    I must confess that I really know nothing professional since I don't start nursing school until next week, but I have a personal experience that is related. When my first baby was born, I had emergency c/s and was put under general. Mind you; liver enzymes through the roof and platelets down to 20,000 (I bled alot) due to severe HELLP syndrome.
    I'm sorry for your horrendous experience, and like Deb, believe there are too many things wrong with your situation to even start dissecting it. Suffice it to say, you shouldn't have been left alone that long, even as a normal CS.

    As for the OP, we also pull the spinal/epidural in OR, and use Morphine PCA, as it seems many other places do. We have just started using Duramorph (Thank God!) Occasionally, we use Toradol, but the OB's don't like to use it too much because it increases bleeding risk.
  7. by   epiphany
    I spoke to the anesthesiologist, and apparently what happened was the cap came off the epid. catheter right after the c/s. Normally, she would have given the Duramorph right before she removed it, and tide the patient over with Taradol for a couple of hours until it kicked in. Apparently the md's forgot the PCA order until I spoke to them, and I am speculating that because they didn't want to have to give the IV push morphine themselves (we not allowed to give IV pushes per protocol), they ordered it sc for me to administer. I can only guess that they didn't order Taradol for the same reason and/or because of the pt's asthma. However, as I learnt later, the pt didn't have asthma according to her records. It's a mystery both to me and the anesthesiologist why the md's thought so. Lesson learnt: read pt's charts thoroughly and don't take what anyone says for granted.

    PCAs are rarely used, thus the frantic search and trying to figure out how to use it. Also, if the pt.'s nurse had been on top of this, it wouldn't have happened. Welcome to my reality, I guess. I am in big crazy city hospital where the interns and residents come to "slum it". I know I made my choice to take this job for various reasons, but sometimes when I hear you nurses share your stories, I am quite envious of the crap that you don't have to put up with.

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