Broken Bones and Pain Management

P_RN, ADN, RN · Mar 2, 2002

Now one thing to remember with PAIN...is an extremity that is too painful, that is PAIN out of proportion for the injury.....just MIGHT be compartment syndrome! And in that case you DON'T elevate.

5 Ps

Paraesthesia

Pain

Paralysis

Pallor

Pulselessness.

Diagnosis is urgent. Done with a Wick Catheter. Delay can be catastrophic. So don't just assume that your patient is drug seeking. Check those limbs. A fasciotomy just might save the leg/arm etc.

Now back to the discussion :)

Dazedgiggle · Mar 2, 2002

I'm definitely with the whole oxyconting q 12 and oxycodone 5-10 for breakthrough pain. I'm also a fan of NSAIDS, but for ortho I really do think you need the narcs. Toradol is great, but you can only use it for a limited time (someone mentioned it, 72 hours), it's not really recommended for people >65, and you need to keep an eye on creatnine. Ice seems to work wonderfully for these people also! And it's so simple! Positioning can help and stratigically placed pillows. Our hospital is also going to be piloting a volunteer Reiki program soon, not sure how that will work. And I've heard therapeutic touch helps, but again, I don't know much about it. Hope this helps!

Home Health Columnist / Guide · Mar 2, 2002

panda--above info accurate info outlined these sites...

overview of types of pain management:

http://www.sepaincare.com/pain_acute.htm

the management of postoperative pain

world federation of societies of anaesthesiologists (england)

http://www.nda.ox.ac.uk/wfsa/html/u07/u07_003.htm

acute pain management in the perioperative setting

... these guidelines focus on management of acute pain in the perioperative setting for ... to inpatient and outpatient surgery. these guidelines are intended ...

http://www.asahq.org/practice/pain/pain.html

acute pain management (clinical guide)- gold standard everyone uses extensive info

clinical practice guideline acute pain management: operative or medical procedure

http://hstat.nlm.nih.gov/hq/hquest/db/local.arahcpr.arclin.apmc/screen/tocdisplay/s/48593/action/toc

the oxford pain internet site (england)

http://www.jr2.ox.ac.uk/bandolier/booth/painpag/

pain after surgery or injury

http://www.medbroadcast.com/health_topics/health_conditions/pain/acute_pain/index.shtml

wake forest university pain index:

listing of acute and chronic pain links

http://www.wfubmc.edu/surg-sci/ns/pain.html

aus nurse · Mar 2, 2002

PRN thankyou for the translation.

Hopefully it won't take me too long to work out the different names, until then thanks.:)

We use Tramal a lot in our hospital for all post-op. It either works really well or not at all, if that makes any sense.

Kidsrus, we have recently just had a seritonon syndrome just as you described...combination of Tramal and Zoloft. Pretty scary as it took a while for us all to work it out. Guess who finally thought it through????? The nurses!!!

Anyway thanks for putting up with my ignorant questions...there's plenty more to come I'm sure!!! LOL :roll

panda_181 · Mar 3, 2002

NRSKaren, that is great! Thank you so much for your help. I haven't looked at them yet, but I'm sure this will be VERY helpful for my paper! Does anyone else have some internet sites that I could look at? I need to be able to reference stuff too. You guys are great!

Amanda :)

Jenny P · Mar 3, 2002

Panda, please do your own research. You are on the internet already, we can't do the homework and research for you. (BTW, this has been a good discussion on this thread! I've learned a lot here!)

Dave ARNP · Jan 6, 2004

IV, Dilaudid. And ONLY Dilaudid. Nothing works NEARLY as well!

For PO, if we're talking about a major fracture, and they need alot of medication... DO NOT BE AFRAID to write Oxycontin. So many people in my area have abused it, that alot of doc's won't even consider a script for it. It, given with either Oxy IR or Percocet are Ortho's best friends.

For milder breaks, non surgical reductions... Percocet 10/325 taken Q4. May also take two if needed.

Dave

Painless01 · Feb 11, 2004

This is great guys, and keep it coming...but do you have any non-medication tips as well?
Amanda :)

Narcotics can be a two edged sword. They work to control pain but they cause respiratory depression, confusion and severe constipation. For hand to shoulder problems, brachial plexus blocks with weak local anesthetics give complete pain relief and NO sedation. This is very nice if your patient has a a bad hx of smoking or long hx of pain relief or heart problems. The same goes for femoral nerve catheters at the groin, popliteal fossa blocks at the knee, etc, etc.

laurakc · Feb 13, 2004

I used to work on ortho and have tried many combinations...

PCA pumps are really great..they relieve the anxiety that many people have from total knee or hip surgery...and from broken bones.

Dilaudid is the best...morphine will work for some...as was mentioned earlier, ice, elevation, position of comfort...

As for hip fractures, Buck's traction has done wonders for many people I have taken care of that were having spasms tokeep the leg from shortening...although valium is also quite nice...another thing that someone once told me and I have found to be very true is do not ever take a pillow out from under a leg (fractured hip) unless you are applying traction...the leg will become increasingly shorter until surgery...

Post op, once the pca is d/c'd, oxycontin...oxycodone ir or percocet for breakthrough pain...vicodin...methadone...but in the elderly, sometimes this is not all neccessary..

Also, pt education prior to surgery is absolutely the most important part of thie care...if you expect not to feel any pain and are experiemcing some, it intensifies the pain...

Ortho_RN · Feb 13, 2004

Our Drs refuse to use Oxycontin now... We had several pharmacies broken into near the hospital, so there have been law suits about it..