What kinds of pain management protocols for Ortho patients are used at your facility? Which do you find most effective and for which patients? I am specifically interested in pain management for the elderly, many of whom go bonkers from opiates, scaring their families and making us crazy trying to care for them post-operatively. Spread your wisdom.
Feb 25, '02
mjamesRN, I used to work in orthopadics we had a lot of joint replacements there were several types of analgesia used .The standard IMI ,the PCA patient controled analgesia where the patients pushes the button for iv narcotic ,epidurals and continuos femoral nerve block using epidural type catherter this last metod was my favourite and did not appear to have any long term side effects.MHN
Jun 25, '02
I work in a orthopaedic elective area, and I favour pca's rather than epidural's as once epidural's are removed, their pain is severe, going from no pain to a lot of pain. tramadol and panadol work well together given as charted,even kaponol and severdol. With acute elderly common fracture being NOF more often than not they become confused on onset of injury,and becomes worse while waiting for surgery which can be up to 2-3 day's that's when iv fluids are essential, pr panadol is good but i have noticed when the elderly are given tramadol they become very nausous.
Long acting opiates are the best bet. cheers. Neat Nurse
Jun 26, '02
I've been in orthopaedics since 1978.
We only kept our epidurals of Marcaine/Fentanyl in until the morning after surgery. Studies had shown that hematomas could develop in patients with epidural analgesia AND receiving SQ Enoxeparin. The epidurals were in a PCA mode with a continuous rate also. The enoxeparin would be started 4 hours after removal.
As soon as the epidural was pulled, the patient received OxyContin 20mg (I think) BID, with oxycodone/tylenol for breakthrough. We rarely had a patient complain of severe pain. And rarely did we need a PCA IV narcotic.
Isn't it funny how we have such similarities all over the globe!
Jun 26, '02
I work in a LTC facility. We have a contract with CCF so we get all their ortho patients. Our protocol consists of Oxycontin 20mg BID with Percocet 5/325 one q 4 hours PRN for breakthrough. This has been very effective for the most part. Due to the ever popular Beers List, we have done away with DN100. If we find a resident is not controlled with this regimen, we up the Oxycontin to 30mg in the AM and 20mg at HS. And up the Perky's to 2 q 4 hrs PRN. Most of our Medicare unit are all hips and knees. This seems to work.
Jul 18, '02
Hi, I work in acute and elective orthopaedic surgery in a large NZ hospital, we use various forms of pain management, I like femeral nerve blocks especially for knee joint replacment patients, We use a lot of subcut morphine,and Tramadol, We use PCA ,s all the time but they usually have a 50ml syringe filled with 50mg in 50ml of Normal Saline, so we are still using the opiates We occasionaly get patients with Epidurals. Normally our elderly #NOF patients have femeral nerve blocks and subcut morphine 2.5-5mg Q1-2 hrly PRN.
Dec 6, '02
As an RN in home health (we see lots of knees/hips post-hospital) and the wife of a bilateral knee patient, I have several different perspectives. It seems to be that when the patient has a nurse as a family member, the case never goes by the book. LOL
My husband had an epidural (next time I would insist on general) and he reacted to either the fentanyl or morphine 5 mins after they brought him back from recovery and stopped breathing right in front of me. So, 2 hours after surgery he was given Narcan and was in an incredible amount of pain. This prompted severe Vaso-vagal episodes where his hr would drop to 20 and he would pass out.
After 2 days in ICU he was taken of off Demerol PCA and started on Oxycontin which made him hallucinate (After 4 days of living at the hospital I thought he was stable and went home to feed dogs, get more clothes, etc. The nurses called me in the middle of the night because he wouldn't let any of them in his room.)
Ortho had no idea what to do with him. He had been on hydrocodone 10/650 prn before surgery for pain with no adverse reactions. Doc decided to let him have 2 q2-3 hours for pain. A day later I did the math and realized he was getting a toxic dose of Tylenol and had them change it to 10/325. The hydrocodone did a mediocre job of pain control but we ran out of options.
As nurses, remember please that each person is different and the knee surgery especially is very very painful. My experience taught me alot and gave me a whole new perspective. On follow up visit I told the surgeon to let me know if he ever needed to do any work on his knees in the future ahead of time, I would be going out of town...LOL
Dec 6, '02
Isn't it so true!!! I dread having my family go into the hospital.......it seems just as you say it's bound to go awry.
But as for the fentanyl or morphine....usually they are used in the OR and in PACU before the epidural pump is set up there to be used on the floor. Usually it also has one of the "caine" drugs...we use marcaine.
I believe I would still go for the epidural myself, but you and your husband sure didn't have a very good experience!!!!!
May 24, '03
our most common form of analgesia is epidural for total knees, PCA for total hips and total knees and sometimes disk fusion. Or po, IV analgesics after the second P.O.D.
May 24, '03
nursindaz Welcome to allnurses.com!!
Feb 26, '04
would like a cheat sheet for post op care hip ,joints esp. postioning and what to look for that indicates problems with recovery