Pain control for CEAs

I am wondering what the general consensus is with regard to pain control for post op CEA patients. In the hospital I am currently at, CEA patients are only written for tylenol for pain, and very rarely will they ever give something stronger. Their rationale is, of course, the importance of monitoring neuro status in these patients. But if this was the case, shouldn't we be witholding narcs on all cranis and other neurosurgeries as well? The last hospital I worked at, they had no problem giving carotids morphine or percocet, and the patients did fine with it. It seems cruel to me to withold these pain meds when they have done a surgical incision on someone's neck! Is this common practice anywhere else?

I'll preface this by saying that I work in a teaching hospital. I've found that it's usually the "old school" or "seasoned" or "well traveled" physicians (insert whatever word you want for "older") who will hesitate in treating pain for CEA's. It's usually the residents who will adequately treat them for pain, not the "wiser" attendings. I don't think a couple percocets q6h or even 2mg morphine q2h is going to snow a patient so badly that you can't monitor neuro status. And, for CEA's, it's not neuro status that's the biggest fear anyway...it's the BP dropping due to baroreceptors that were previously being dampened due to lack of blood flow in that area. If you have enough room with BP and respiratory status, the above mentioned meds are usually adequate and aid tremendously in healing. You'll find numerous journal articles citing everything from PCA's to epidurals to IV and PO meds to support you.

Our CEA patients generally have morphine ordered for the first 12 hours or so, then either tylenol #3 or lortab. I do make sure that I get a base line neuro assessment before I give any narcotics to these patients.

Sorry I know this is an older post but I put in a search for pain management for Cranis and this popped up. I had surgery in my brain stem and I was immediately put on a PCA. I think if a patient is in a lot of pain from a CEA a PCA might be appropriate for them. The PCA did not have ANY effect on my neuro status and the meds in my PCA were at a higher rate than the baseline because of my tolerance. Anyway I work on the neurology/neurosurgery floor and I have taken care of many patients with CEA's. Depending the patients tolerance to pain or if they have other chronic conditions it depends on what they get for pain. If a CEA patient has a high tolerance to pain they usually get 10mgs of oxycodone. If a CEA patient is in terrible pain and or has another chronic pain condition they get a PCA for a few days. That is what is great about PCAS(from my personal opinion I've been on one 3 different times) they keep the pain under control without knocking them out by way of IVP Dilaudid/Morphine/Fentanyl. Anyway it's my personal opinion(my own brain stem surgery and being put on a PCA with a .5mg basal rate and .6mg bolus rate of dilaudid..of course these patients don't get that high of a dose unless they have a tolerance to opiates and the pain service evaluates them) thrown in what we do on the neuro floor.

this is interesting. we don't give pain meds unless they were on narcotics for chronic issues. no pain meds but dopamine for bp. Although reperfusion injury is not that common I have seen it and am cautious with any pt asking for strong pain meds after cea