Need opinion on IV Pain Management

MS69 · Jul 4, 2009

I think patients do much better in regards to pain management when they do not arrive in PACU crawling out of the bed because they are in pain. When patients receive small doses of Fentanyl or Morphine during the case it is much easier to control pain post op. Toradol seems to be much more effective if given during the case. I have observed that patients who receive Toradol intraop require less narcotics in the PACU. Patients who are on Chronic pain meds at home also need to have orders for dilaudid post op rather than Morphine 2mg every 5 min. to max of 10mg. Come on this will never work. Controlling nausea is paramount as well. Patients who receive Zofran prior to induction seem to do better. Pain control post op takes time and experience. It really is a fine line sometimes between control and breathing.

MS69 · Jul 4, 2009

I think patients do much better in regards to pain management when they do not arrive in PACU crawling out of the bed because they are in pain. When patients receive small doses of Fentanyl or Morphine during the case it is much easier to control pain post op. Torsdol seems to be much more effective if given during the case. I have observed that patients who receive Toradol intraop require less narcotics in the PACU. Patients who are on Chronic pain meds at home also need to have orders for dilaudid post op rather than Morphine 2mg every 5 min. to max of 10mg. Come on this will never work. Controlling nausea is paramount as well. Patients who receive Zofran prior to induction seem to do better. Pain control post op takes time and experience. It really is a fine line sometimes between control and breathing.

PostOpPrincess, BSN, RN · Jul 4, 2009

Listen to the PACU RNs where you practice and ask them what drugs they want to manage with.

joyouter · Jul 4, 2009

Good Pain management starts with the anesthetist knowing the patient, prescribing and initiating post op pain meds prior to arriving in the PACU and above all, recognising chronic pain patients so that adequate and appropriate pain control takes their present pain Rx into account. Your best source are the PACU nurses who will clearly inform you about the scheduling and preferences of pain meds and anti emetics. Good luck!

Andrew, RN · Jul 7, 2009

Hey, Great post! Pain management varies from person to person. It's about finding what drugs and doses works. We're all snowflakes. =) This is something I've been very passionate about and interested in. I've been a PACU RN for just a short period of time but I hope my input helps!

1. What drugs are preferred?

You'll find your own favorites as you practice. The best CRNAs/MDs I've seen give something longer acting during the middle/end of the case in combination with their fentanyl, which works fast but doesn't last very long. 1mg hydromorphone or 5-10mg of morphine intra-op for an average adult is a pretty safe bet. It all depends on the patient, what meds they take, and the type of surgery.

2. What drugs do you like anesthesia to use? And why?

I'd like them to have their pain controled and not be puking. So, add ondansetron/promethazine/metoclopramide to the above list. Scope patch pre-op for the extra queezy ones.

2. What drugs do you not like? And why?

Darvocet. Surgeons order it all the time. It's a lamesauce drug for treating pain. Too much acetaminophen to boot.

3. Do you notice a difference in recovery time in those who are properly narcotized?

Everytime the PACU RN has to re-dose the pain med, that adds about 10-15 minutes (depending on facility policy) to the time they have to be in PACU for monitoring. Definitely shorter stays are noticed if pain is managed effectively. I try to pre-emptively treat someone's pain so that at the last minute before they go to their room they don't start hurting. Asking them to hold their incision (if its abd) and cough or adjust themselves in bed slightly is a good way to see how they feel. They could be 100% pain free laying completely still but then have 7/10 pain once they move a little. On the floor, they are going to be up and walking around, it's good to make sure they're at least at a tolerable level for that.

4. Do you believe that too little/too much pain medication is generally being used?

Depends on the facility. Depends on the anesthesia provider. One CRNA would give me people not breathing more frequently than their colleagues would. They gave too much. The very old and the very young get significantly less narcotics than any other demographics. You want your patients to be pain free after surgery, but you also want them to be awake and breathing too =)

5. What do you think anesthesia does/could do different to assist you with post-op pain management?

Most of the anesthesia providers I have worked with are fine with giving you more/different drugs if things aren't working.

Hope this helps! I'm a new RN but I love PACU!