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Discussion

Barbaric MD!

Yesterday in my NICU an ENT Dr. cut a baby's frenulum (sp.?) WITHOUT any pain control. I didn't have the baby but was in the room. I suggested pain control out loud to the nurse and the resident. The MD had already told the parents he wouldn't need anything for pain. "I only cut 3mm" he said. Hey, let me cut 3 MM out of YOUR mouth! That's what I felt like saying. The resident mentioned Morphine and he ignored her. The baby screamed for a few minutes, not long, HOWEVER don't you think he could have used topical lidocaine or SOMETHING? They numb babies now for circs! Why not the mouth?

I have braces and I know how painful the mouth can be. I was given topical lidocaine by my orthodontist, so I know it works.

Have any of you ever seen this frenulectomy procedure without meds?

The baby got Tylenol AFTERWARDS, oh well. I just thought it was MEAN.:madface:

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  • Experts

There is no reason why that child couldn't have had preprocedural pain control. I would have placed the incident in my hospitals online event-reporting system, emailed my manager, and set up a time to discuss this. This, if not anything else, is a JCAHO violation.

I am a hop, skip and jump away from walking away from my current job if improvements are not made to managing babies' pain here. No one listens.I have been witness to a gross lack of pain management. I have filed multiple reports in our system, and seen my manager many times. I have told my manager that I will stay and try to fix what I see is wrong with the unit. But I also told him that if I don't feel like anything is changing, I will go work somewhere where the staff/physicians practice ethical care.

I had a similar situation a couple of weeks ago. A doctor wanted to dilate a babies orifice and wasn't going to bother with pain control. I put my body in between the surgeon and the baby and said that we needed to give the baby fentanyl first.

I was trying to be tactful so the family didn't lose confidence in the surgeon, but I am very protective and will not let one of my patients undergo anything potentially painful without pain meds on board.

This surgeon is a nice guy, but he is old school and doesn't believe that newborns feel pain.

Yesterday in my NICU an ENT Dr. cut a baby's frenulum (sp.?) WITHOUT any pain control. I didn't have the baby but was in the room. I suggested pain control out loud to the nurse and the resident. The MD had already told the parents he wouldn't need anything for pain. "I only cut 3mm" he said. Hey, let me cut 3 MM out of YOUR mouth! That's what I felt like saying. The resident mentioned Morphine and he ignored her. The baby screamed for a few minutes, not long, HOWEVER don't you think he could have used topical lidocaine or SOMETHING? They numb babies now for circs! Why not the mouth?

I have braces and I know how painful the mouth can be. I was given topical lidocaine by my orthodontist, so I know it works.

Have any of you ever seen this frenulectomy procedure without meds?

The baby got Tylenol AFTERWARDS, oh well. I just thought it was MEAN.:madface:

A few years back I had my front tooth worked on and they pulled back my upper lip so far up that mine completely tore... it was so sore - they never mentioned anything about it. It was awful and hurt for quite a long time....

I had a similar situation a couple of weeks ago. A doctor wanted to dilate a babies orifice and wasn't going to bother with pain control. I put my body in between the surgeon and the baby and said that we needed to give the baby fentanyl first.

I was trying to be tactful so the family didn't lose confidence in the surgeon, but I am very protective and will not let one of my patients undergo anything potentially painful without pain meds on board.

This surgeon is a nice guy, but he is old school and doesn't believe that newborns feel pain.

ohhhh god, good for you - I made the mistake of being in the room with my second son having a circ 10 days after birth - with my sister-in-law and my 3 year old son... the block did not work - he felt every snip. I thought he would stop breathing from the pain and the horrific cries....Needless to say, I'm against Circs now... my poor babies!

  • Experts

I would put in an occurrence/incident/quality variance/whatever report. Point out that it was a JACHO violation.

The baby could have been given Tylenol before the procedure, as well as topical lidocaine. Geez, Doc, what are you thinking??

  • Author

I sent an email to my manager and she is forwarding it to our CNS. Manager agreed baby should have been given something beforehand!!:cry:

My DD had that done by a plastic surgeon and she was given cons. sedation! They did a Z-plasty on her, they just didn't snip it! Holy moly, if I were that parent I would be ******!

  • Author
My DD had that done by a plastic surgeon and she was given cons. sedation! They did a Z-plasty on her, they just didn't snip it! Holy moly, if I were that parent I would be ******!

I was surprised the parents agreed with the surgeon before the procedure that the baby didn't need any sedation! As he puts it "I just cut of 3mm."

The parents didn't watch the procedure. I felt like I was really the only nurse in the room that was so mad! The 2 others didn't seem too concerned about it.

I was a registered dental assistant for 3 years and have seen MANY frenectomies. The dentist always uses some kind of pain med to make the patient comfortable even if really wasnt needed. A little topical couldn't hurt. Plus, that baby is going to feel some pain for a while too. We all know how it feels to have a little sore on your lip or gums, its painful. What a dousch!

How awful!!!

I guess, as NICU nurses, that you all know that until relatively recently, preemies weren't given any pain killers during procedures, even surgeries, because it was believed that they couldn't feel pain like "normal" babies. It wasn't until the parents of preemies demanded change that things improved.

SteveRN21, why do you think there is such a situation in your unit?

  • Experts
How awful!!!

I guess, as NICU nurses, that you all know that until relatively recently, preemies weren't given any pain killers during procedures, even surgeries, because it was believed that they couldn't feel pain like "normal" babies. It wasn't until the parents of preemies demanded change that things improved.

SteveRN21, why do you think there is such a situation in your unit?

Several reasons.

1. The head honcho of respiratory management in our unit is an old school anesthesiologist who believes narcotics are too risky in neonates, and that babies don't feel pain.

2. Old habits die hard. He's worked here for 35+ years, and everyone's afraid to stand up to him.

3. A sucky pain scale we "developed ourselves." I guess NPASS was too mainstream for us.

4. The dinosaur nursing culture of the unit.

5. ONE pyxis for 80 babies. About a 5-10 minute expedition from the ECMO pod. God forbid your baby gets acutely agitated and you need a stat dose.

And a deeply entrenched belief (courtesy of said ancient respiratory doc) that the tiniest shred of independent respiratory effort trumps any amount of pain, no matter how large, because they "won't remember it". Seriously. Someone said that to me as an honest attempt at justification the other day.

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