Explaining post op pain to patients

Perpetual Student · Jun 12, 2011

Don't you just love it when someone is shocked to be in pain after surgery? :uhoh3:

At my hospital the admitting nurse is supposed to explain that pain is normal and how to rate it. A lot of patients apparently don't get the message, though. Young patients in particular seem to have unrealistic expectations.

Yes, surgeons should explain to their patients that they will have pain, but many seem to drop the ball or minimize it. I'm not sure what we can do other than keep encouraging the pre-op nurses to emphasize that some pain is to be expected and that the PACU nurse will work to MINIMIZE it, not eliminate it.

brownbook · Jun 12, 2011

I have never had this happen to me, after 10 plus years working PACU?

I hear co-workers mention it once in a while it but it seems almost anecdotal to me?

As soon as our patients are somewhat awake, responding, we ask them if they are having pain and administer pain medication per anesthesia orders and our nursing assessment. We give them pain medication and tell them if that doesn't have any effect in 3 - 5 minutes we will give them more until the pain goes down. We tell them the pain might not reach zero for several days, (scale one to ten) but we can get it down to a tolerable level.

If I have a patient complaining of pain above 8ish for some amount of time I change to a different narcotic or tell the anesthesiologists?

Also anesthesia can and does give the patient pain medication while they are still in the OR, prior to coming out to PACU, if the patient wakes up and starts to complain of pain.

I hate to be blunt but are you or your anesthesiologists letting your patients pain get ahead of them?

Are your patients from a different socioeconomic or cultural class? I find it hard to think an average person of average intelligence would think their skin, muscles, bones, etc., can be cut into by a surgeon and it won't hurt? No matter what a surgeon might tell them?

vintagemother, BSN, CNA, LVN, RN · Jun 14, 2011

I have never had this happen to me, after 10 plus years working PACU?
I hear co-workers mention it once in a while it but it seems almost anecdotal to me?
As soon as our patients are somewhat awake, responding, we ask them if they are having pain and administer pain medication per anesthesia orders and our nursing assessment. We give them pain medication and tell them if that doesn't have any effect in 3 - 5 minutes we will give them more until the pain goes down. We tell them the pain might not reach zero for several days, (scale one to ten) but we can get it down to a tolerable level.
If I have a patient complaining of pain above 8ish for some amount of time I change to a different narcotic or tell the anesthesiologists?
Also anesthesia can and does give the patient pain medication while they are still in the OR, prior to coming out to PACU, if the patient wakes up and starts to complain of pain.
I hate to be blunt but are you or your anesthesiologists letting your patients pain get ahead of them?
Are your patients from a different socioeconomic or cultural class? I find it hard to think an average person of average intelligence would think their skin, muscles, bones, etc., can be cut into by a surgeon and it won't hurt? No matter what a surgeon might tell them?

I only have the pt perspective at this point, but you sound like you or your hospital has an awesome system of staying on top of pain to prevent it.:)

I actually have been surprised to feel pain after the pain meds wore off before, because of the factors you mentioned - sometimes they give you post op pain meds and you don't realize that you feel so good after surgery because you are still drugged. Not until it wears off do you feel the pain. And, like you so kindly mentioned, it's helpful if the staff does offer meds to stay ahead of the pain.

This makes me think what happened to my sis in law after her tubal ligation/c-section. They discharged her without telling her she was on drugs the whole time at the hospital. So when she got home, she thought something ruptured inside of her, the pain was so excruciating. This was her 4th c-section, and this time, she felt like something was majorly wrong because it hurt so bad. After a lot of phone calls and a trip back to the hospital to try to find out what was wrong, we found out she simply was supposed to feel like that, since she hadn't taken her pain meds.

So, yeah, maybe us patients do need to be educated because we don't all get it. And not all medical pros explain it to us, either.

leslie :-D · Jun 14, 2011

as a recent pt., i found the post-op experience to be surprising.

my surgeon downplayed the post-op as very benign.

while it was only an overnight stay, it took me close to a week to feel fairly functional.

immediately post-op, i was given dilaudid, which helped the pain to around a 3.

then i was put on a fentanyl pca, and i'm serious, this did nothing.

it did so little, that i stopped using it all together...

so the nurse asked if i'd like to try toradol.

it worked like a charm.

for the rest of the hosp stay, i only wanted toradol...

but since i could only have it q6h, she encouraged me to continue using fentanyl.

having a chest tube hurts...

esp when you need to deep breathe and cough.

i felt horrible for the first 4-5 days, and the surgeon acted surprised.

now i know that post-op pain is real, and shouldn't be downplayed...

nor should it be "expected".

i expected pain to stay under a 5...i felt that to be reasonable.

i'm glad it's over, for now.:)

leslie

Munch · Aug 15, 2011

I had the same problem when I had my craniotomy. My surgeon acted like the post-op period would be a piece of cake....WRONG. The surgery was only supposed to last 2 hours, it went on to last 4 1/2 hours so more things were cut thus more pain arose. I remember being wheeled from the OR to the PACU still in an anesthesia haze yelling how much it hurt. My neurosurgeon ordered a dilaudid PCA. Of course it took a little while for them to set it up so the PACU nurse kept giving me dilaudid injections. I had told the Dr and his NP days before the surgery that I have been a chronic pain patient for 3 years and my tolerance was higher than your average bear. Before the PCA was set up they were only giving me injections of .4mgs of dilaudid which for someone with tolerance didn't touch the pain. They set up the PCA and still the dosage wasn't high enough. Finally after being in the PACU for 6 hours(I was in the PACU for almost 24 hours until a Neurosurgery ICU bed became available) they finally called the pain service to come evaluate me. They had to call my pharmacy to make sure the pain medication I was on prior to the surgery was legit and she upped the PCA a little bit and allowed a 1mg shot of dilaudid every 3 hours(the PCA didn't have a basal rate). After that was all squared away, it didn't completely take all the pain away, but it did make it more tolerable..I was no longer crying. It shouldn't have taken so long though to get the PCA dosage right, they should have been more prepared as opposed to me waiting HOURS post-op to get some relief.

tewdles, RN · Aug 16, 2011

I also have recently been a post op patient...twice in 30 days...and nobody spoke to me about post op comfort prior to the surgery. Oh wait, we did talk about the use of an epidural in addition to my gen anesthesia for the second (DaVinci assisted) procedure.

What I was not prepared for was the DC of the epidural without adequate po opiate coverage to keep me comfortable. I found myself in a pain crisis with pain 10/10 requiring IV Dilaudid to get to 4/10. WTH?!? Why didn't they cover me proactively to prevent that little episode?

This happened, of course, on the med surg floor, not in the PACU.

I personally think that nurses have to be very proactive about this education and care because too many physicians are not, it should be part of our advocacy.

xtxrn, ASN, RN · Aug 22, 2011

I've had surgery both with the IM pain meds and PCA. I h a t e PCAs....just doze off feeling a bit better, and then wake up with the IV stuff worn off and have to keep pushing the stupid button q10 minutes to get ahead of it, only to doze off again- from the drugs, not having adequate pain control....I have chronic pain- I'm used to sleeping with pain (the contact with the bed actually hurts- and the bed is fine- it's any bed I've been on) so the "if you doze off, you're ok" theory is crap. With IM meds, they last for 3-4 hours, and it's possible to actually get comfortable with less meds. :twocents:

Lap choleys are a big issue w/pain control at places I've worked- the Co2 moving into the shoulder/collarbone area isn't explained well enough and patients don't want to move (which is the only real 'fix') to get it dissipated. :cool:

Patients also don't want to have to feel anything (sorry bud- someone just stuck a knife half way to the other side of you- think it's gonna tickle? :uhoh3: ).

There's a serious wuss situation with surgical pain- at least with some . There are those who suck it up (and really should get more pain meds to facilitate mobility) and then there are the "I'm too good to put up with pain" folks who are never satisfied. :mad:

Education is definitely lacking with some folks- but there are also a lot of unrealistic expectations. :)

tewdles, RN · Aug 23, 2011

I loathe pain on a personal and professional level.

Isabelle49 · Aug 27, 2011

There is no reason whatsoever for a patient post-op or not to have pain that is way above their comfort level. Pain is the 5th Vital Sign and should be taken very seriously. It causes a release of adrenalin, the fight or flight hormone that raises the heart rate, blood pressure, blood sugar levels and causes increased anxiety/agitation in a patient. There is nothing beneficial to be gained here. A patient who becomes anxious and agitated because of severe pain may not respond to the pain medicine alone. I found in PACU that these patients often needed an anxiolytic prior to the pain medication to achieve an acceptable level of comfort.

My theory of the level of pain a patient experiences immediately post op is not only dependent on the type of surgery performed, but more than that, the effect of the anesthetic reversal given to the patient prior to transfer to the PACU. The reversal cancels out the anesthesia, anesthesia is not feeling pain, so what happens, the patient is about crawling out of the stretcher, screaming in pain. This shouldn't happen and needs to be addressed immediately in PACU with anxiolytics and opioids. So what if the patient stops breathing, they are in an intensive care are and can be managed. Pain relief is of utmost importance.

nyrn5125 · Sep 6, 2011

I've had surgery both with the IM pain meds and PCA. I h a t e PCAs....just doze off feeling a bit better, and then wake up with the IV stuff worn off and have to keep pushing the stupid button q10 minutes to get ahead of it, only to doze off again- from the drugs, not having adequate pain control....I have chronic pain- I'm used to sleeping with pain (the contact with the bed actually hurts- and the bed is fine- it's any bed I've been on) so the "if you doze off, you're ok" theory is crap. With IM meds, they last for 3-4 hours, and it's possible to actually get comfortable with less meds.
Lap choleys are a big issue w/pain control at places I've worked- the Co2 moving into the shoulder/collarbone area isn't explained well enough and patients don't want to move (which is the only real 'fix') to get it dissipated.
Patients also don't want to have to feel anything (sorry bud- someone just stuck a knife half way to the other side of you- think it's gonna tickle? ).
There's a serious wuss situation with surgical pain- at least with some . There are those who suck it up (and really should get more pain meds to facilitate mobility) and then there are the "I'm too good to put up with pain" folks who are never satisfied.
Education is definitely lacking with some folks- but there are also a lot of unrealistic expectations. :)

Very true with the lap surgeries. They don't tell pt's how painful it is and that only walking helps to relieve that Co2 pain. Pt's think if they lay there and never move it will go away. It's best to prevent the pain than to try to catch up to it. Give the prn automatically and if it isn't enough call MD and get it adjusted, don't wait. We get pt 4 hours post op lap sx,vascular bypasses. Some docs hate giving too much pain meds yet want them up and oob.

RaineyRN · Oct 16, 2011

"I hate to be blunt but are you or your anesthesiologists letting your patients pain get ahead of them?"

Anticipate that there will be pain! Pain meds shouldn't be relient on a pt telling you they're hurting. You know they will be, so load em up! It's always easier to control pain before they are fired up... stop the cascade before it starts... :-)