post-op pain for spinal surgeries

[amyBSN]

I am an orthopedic nurse and absolutely love my job. Our population of back surgeries is growing (lami's, fusions, cages, kypho's etc), and I've noticed that this populations of patients' pain is more difficult to control than total joint replacements. For many of these people, they have been living with chronic back pain and have been taking pain meds for quite some time. Has anyone elso noticed this and if so, what are your patients ordered for post-op pain?

[sharann, BSN, RN]

Hi Amy,

I work Recovery not ortho, but most of our post-op's are lami's and other ortho cases. Our neurosurgeons usually have us initiate a PCA of Mosphine or Dilaudid, with bothe continuous and demand settings. They also tend to Rx for prn Valium 5mg IM every 4 hrs for "spasms". The pts I see are at the immediate post-op phase and almost all come out of the OR screaming, thrashing and moaning. It takes a good hour to control the pain so they are comfortable to rest. I have no clue what they give after the PCA is DC'd, but theyr'e on it for at least a full 24-48 hrs. I believe they have an oral regimen after this.

Hope this helps.

[sharann, BSN, RN]

OOPS, forgot to mention, that the one's who are long term opioid users or addicts(occasional), pain control is a HUGE challenge. The anesthesiologist may be assigned to do pain management. Does your hospital have a pain team. If not, maybe you should look into starting one...

[ga.bones]

The valium is the trick-we give 1-2mg q2h IV for the fusion cases. the lamis are mostly micro and have minimal pain.