pain & external fixator

[PediRN]

fx my distal radius last monday. had closed reduction and internal & external fixation done on friday. unbelievable pain, 10/10 most of the week. After ambulatory surgery was given dilaudid for pain. 4 mg q4h wasn't touching pain so I went to the ER. Got 1 mg X 3 IV dilaudid (spread out over 4 hours) which brought pain down to 3/10. Was sent home with same rx, orthopod said "4 mg dilaudid would knock me out, any more than that could stop your breathing". Decided on my own to increase dilaudid to q3h to try to stay ahead of pain. woke up after 2 and 1/2 hrs once again pain 10/10. called covering md who said to take 6 mg q3h. still had pain after 2 and 1/2 hours. went back to ER next morning, now the entire staff is giving me that "drug seeker/ frequent flyer must be a junkie" look. told them my pain was 10/10, had to wait over 1 hour for any pain relief. finally got IV dilaudid, but had to get 1mg X2 back to back. this orthopod had the good sense to unwrap my arm (offered some instant relief due to bandages being too tight) and do an x-ray, also pressure tested to r/o compartment syndrome. had anesthesia come by to do a pain consult (what a novel idea) who prescribed 10 mg oxycontin bid.

pain free now for 48 hours.

questions:

operating surgeon said that he does these operations all the time and nobody ever experiences this much pain. true?

same surgeon says that insurance companies never pay for overnight admits for pain control. true?

I know from experience that people used to get at least an overnight admit after these surgeries. Does anyone else here have that recollection?

mostly I just wanted to vent after the horrific weekend and relate oncegain how badly it sucks being on the other side.

thanks for your time

[Antikigirl, ASN, RN]

I can answer the first question with certainty! Everyone experiences pain on their own levels! To lump you into a group of other patients is about as helpful as saying everyone loves apple pie. We know some folks do or don't..and some folks experience pain more than others!

My father fell from a ladder and shattered his distal radius! That was three years ago, and he still struggles with the pain! It was 10/10 and he would frequently pass out from it because he is the type of guy that doesn't like to take pills so he would let the pain go on! UHGGGGG what a nightmare for me! Oxycontin was his only friend in this case, and we watched it very carefully so not to become dependant on it as the only source for pain control (notice I said Dependant, not addicted..large difference! I want to monitor the dependance so it doesn't turn into a addiction...very good train of thought in pain management!).

He stopped using pain meds of any kind daily after about two months, and occasionally has ibuprofen when it flairs up (still like pulling teeth to have him take it too, but once he does he thanks me...oh joy! LOL!).

No..those things HURT, and my father has a very low tolerance for pain, but thick headed enough to not admit it! Which is worse..the patient that won't admit they are in pain and suffer, or the one that speaks up? I vote for the one that speaks up and NEVER use the phrase 'drug seeker' because that just starts out on the wrong footing all together...

Good luck with your pain management and I am sooooo glad they got an anesthesist for you (best of the best...we have many clinics and I insist my patients with chronic pain visit them!!!!). Keep with them, they are much more aware of the complications of pain than any general MD or even surgeons!

[jax]

I'm not suprised you were so sore. OUCH! That's big surgery. The arm needs to be elevated in a gallows post surgery and even then we can still run into problems with swelling - tight bandages -increased pain. I'm not sure what dilaudid is, (Australian nurse), but we would have pt's on s/c morphine overnight, perhaps even a PCA. I feel for you. I'm wincing on your behalf.

[zacarias, ASN, RN]

For Jax, dilaudid is hydromorphone. And PediRN, I am so sorry this happened to you and that you're in so much pain. I've met some awesome CNS pain specialists; they seem to be the type to jump through any hurdles to get people relief. Keep us informed.

[PediRN]

Thanks everyone for your kind words. The pain is much improved. I saw my surgeon today and told him very kindly that he was not at all helpful Friday evening in the ER. He was appropriately contrite.

Anyone else have any input? I would greatly appreciate it.

[Sis123]

Sorry no input to offer other than my sincere sympathies over the pain.

I was just wondering though, did you break this bone at work? (Whatever you did, I'd like to avoid doing that!)

[P_RN, ADN, RN]

pain free now for 48 hours.

questions:

operating surgeon said that he does these operations all the time and nobody ever experiences this much pain. true? Not true at all. While it is true everyone has different thresholds......what you had is a VERY painful procedure

same surgeon says that insurance companies never pay for overnight admits for pain control. true? Not necessarily true. My Blue Cross has to have prior notice from subscriber and then they will call back to approve or disapprove length of stay.

I know from experience that people used to get at least an overnight admit after these surgeries. Does anyone else here have that recollection?

mostly I just wanted to vent after the horrific weekend and relate once again how badly it sucks being on the other side.

Oh yeah, I remember total hips stayed a month, back pains in traction 4-6 weeks sometimes. Heck I was kept for 8 days with my first baby 1968 because I had a 99 temp. Those days have gone forever.

thanks for your time.

BTW your ortho should try being on the receiving end sometime.

You are not a wimp, you were seeking relief NOT DRUGS....relief from horrid pain.

[PediRN]

Sorry no input to offer other than my sincere sympathies over the pain.

I was just wondering though, did you break this bone at work? (Whatever you did, I'd like to avoid doing that!)

tripped over baby barrier. my husband asked if he should adult proof the house.

I shot him

[z's playa]

tripped over baby barrier. my husband asked if he should adult proof the house.

I shot him

So......how much pain is HE in? :chuckle

[rjflyn, ASN, RN]

I was going to add what I tell all my ER pts with fractures- most of the pain you are going to have is related to swelling. The meds can only help so much. The two most important things to do keep it elevated and ice, ice and more ice. With all the padding even with a temp splint as most dont get casted due to swelling is that if you think you have iced it enough ice it some more. Some times the best medicine is free.

rj

[KeniRN]

I work as a precert RN for a Blue Cross plan and we approve 1 overnight stay for pain control with a PCA post op and then for additional days UR follows the patient. I'm so sorry you had to go through all that you did. I'm glad you now have some relief.

[Tweety, BSN, RN]

To be totally honest with you, I've seen people with ORIF's of the radius do very well for the most part and not have that kind of pain. And it isn't uncommon for this to be a day surgery and people get sent home with percocets or vicodin.

That you said you got immediate relief from the unwrapping is telling. You probably had an unusual amount of swelling. 10/10 after this kind of surgery did indeed need some investigation and you did the write thing about going to the ER and your surgeon did well to unwrap it and investigate.

He was wrong to poo poo your pain like that say what he did. He should have addressed your pain.......period.

Ortho pain is very painful, especially after the first day.

Admissions for pain control is a legimet diagnosis for any kind of surgery and I've seen it plenty of times. Maybe admitting for a fx'd radius isn't a good diagnosis, but post-op pain control and observation of pain is, or at least I think it should be.

Good luck to you!