ortho post op pain control - page 3

by nurse96 16,358 Views | 23 Comments

At our facility we used to have a pt come from O.R. to the unit with and epidural already infusing. After a few mishaps (pt not being able to feel legs for a day) we are now starting them only when the pt begins to feel pain and... Read More


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    I forgot to add that some doctors here like using the reinfusion drains (cell-savers they're commonly called) within the first 6 hrs. of insertion (otherwise, the RBC's start to break down) after surgery. But the ones who don't like them cite various studies that link fatty emboli to the use of reinfusions. So everytime I use one, like every day, I wonder if I could possibly be adding to their troubles!
    We recently had a patient have a fatal thrombocytopenic reaction to Lovenox (Enoxoparin, or, low-molecular-weight-heparin) Very upsetting.
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    We only get our total knee patients back with epidurals infusing. THey are basically bedridden for 3 days. We just started getting patients with Femoral and sciatic block that work great also we are going to be getting some patients with a new drug called depodur it is a long lasting morphine type injection that they get pre-op
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    I work on a very busy 52 bed ortho floor. We do probably 30-40+ total joints a week. Our pain protocols have been tweeked over the years by a team of ortho docs and anesthesiologists. Patient's are given Oxycontin prior to surgery, along with a cocktail of other meds to decrease incidence of nausea. They are given intrathecal injections. Oxycontin is started immediately postop and continued X 2 days. There is hydrocodone and oxycodone available for breakthrough pain. If these don't help, Morphine or Dilaudid can also be given. We rarely have anyone with pain out of control. We almost never use PCA pumps. All meds are either po or IV. I can't tell you the last time I gave an IM pain med. Times have really changed in the last 20 years! When the pain is controlled well, patients move better. We are now discharging a good percentage of total hip/knee patients in 2 DAYS!
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    "we have a specific pain relief team that is consulted as needed, which is great. they can get pretty creative with their med orders."

    you are very fortunate to have a pain relief team! i am a first-year night nurse on an ortho/neuro unit. when pain control is a problem it causes me a lot of stress i have asked several co-workers for tips - they each seem to have different approaches. can anyone suggest a resource to help me learn and grow in this area?


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