friends dad/CABG c/o pain

gwenith, BSN, RN · Apr 1, 2004

Usually we give morph/fentanyl because the pain is more of a depressive to respiratory drive than the opiate. If he can't cough he will end up re-ventilated.

nurseunderwater · Apr 1, 2004

thanks gwenith....Her mom requested that pain management be brought in....she also mentioned something about a patch?

PS: I feel so exotic conversing w/ you all the way down there. I think your icon adds to the mystic

zambezi, BSN, RN · Apr 1, 2004

Gwynith makes a good point about the coughing and deep breathing, very important especially if he is having problems with sats/temp...I really like using toradol with MS just after extubation...the toradol is extremly helpful for many people...of course, it can't be used with everyone and we usually only give it for three doses after extubation. We are also using oxycontin either 10 or 20 mg BID for many of our post op patients once they are taking clears...it seems to cut down alot of the frequency of other pain meds...we use percs/darvocets and ms for breakthrough pain. While pain is to be expected, especially during coughing/moving etc...if he can hardly take sips of water it does need to be addressed. Does he still have Chest tubes in? For many of our patients the CT cause quite a bit of pain and once they are removed, pain levels do decrease. Hopefully he is doing a bit better now....

MarkHammerschmidt · Apr 1, 2004

Yup - Gwenith makes the correct point in saying that if your friend's dad can't cough, then he'll really run the risk of postop pneumonia. A fentanyl patch might not be a bad idea, but I like the old way of giving a couple of milligrams of MS04 before doing some good coughing/deep breathing, etc. Small doses, appropriately timed.

suzanne4, RN · Apr 1, 2004

Post CABG, he shouldn't be having problems with his throat to be causing that much pain..................possible have an ENT consult................but still as everyone else has stated, the most important thing for him is to cough and

deep breathe. Use of an incentive spirometer should also be included. I still would go with the idea of morphine about twenty minutes before C&DB.

Another question comes to mind, was he an elective case or emergent? Sometimes adding in a NSAID can help if there is any type of rib inflammation going on which may be giving him increased pain with the coughing..........

Hope that he is beginning to do better by now...... :balloons:

my2sons · Apr 2, 2004

10 year CV veteran here: TORADOL, TORADOL, TORADOL! And ASAP removal of the chest tubes, especially if he is a younger fella. They seem to have more muscle pain.

nurseunderwater · Apr 2, 2004

I found out my friends father was on methadone...?? :uhoh21: .....they weren't giving him his usual dose. I can see how that would have interfered with pain mgmt...

They got his methadone where it needed to be, added a fentanyl patch and got good result with the lower doses of mso4.

Thanks for all the replies. I always learn so much from all of you. :)

my2sons · Apr 2, 2004

ahhh, makes sense.

nexus · Apr 3, 2004

I'm in the UK and patient controlled analgesia is used routinely for post op patients. Is this not the case in the US? It seems strange that patients are still left to suffer severe pain post operatively when all the evidence shows that PCA is best practice.