Post-op pain managment

[crissrn27, RN]

What do most docs do for post op ortho pain? I was talking with a friend of mine about one of the docs that is popular in our area and his pain control methods. He is a real jerk, #1, but that wouldn't bother anyone that much if he at least pretended to care about his pts. My sis had this doc about a year ago for a broken tib/fib and we had MAJOR problems, but I won't go into all that. I'll tell you what he does for ALL of his pts, be it tib/fib fx or femur, or whatever.

1. PO percs and meprigane for at home pain prior to surgery or after set, cast, whatever.

2. After surgery he gives 50-100 mg demerol, and 25 of phenergan q3-4 hours.

3. po percs and meprigane after surgery

No variations, no trying other things if this doesn't work.

Thats it, and his pts are suffering horrible from what my friend tells me. Screaming throughout the first 12 hours post op. When she calls to tell him pain is not relieved he says "well, I guess he/she will just have a bad night". That is the EXACT phrase he used on my sis when she was post op in his care, so I believe her when she says that is what he says. Needless to say my sis got some relief, but only because I was there and pushed them (really hard) and got her something different. After she was all healed up, this doc said "now your sister can play doctor on you like she has been wanting to the whole time" JERK

Anyway, sorry went on a tangent there, lol. To continue.

I don't do ortho, and probably never would by my friend loves it and is very concerned about this, she says no one will listen to her about it (shes the new kid on the block) and that the other nurses tell her thats how he always has done things and nothing is gonna change.

I applaud my friend for wanting to do something about her pts suffering but I don't know what to tell her to do. Any suggestions?

[kiwideb]

find evidence based articles on post up ortho patients, print them out, highlight the "important" bits and post them to his practice

blunt and too the point?? is it not poss to go thru his register or anaethetist or acute pain management team at the hospital?

poor patients!

[sharann, BSN, RN]

Some docs are great with pain relief meds and techniques while others are jerks and incompetent, just like in all other medical specialties. Some PA's and NP's and nurses and Dentists are jerks too though.

If this doc is not doing an adequate job of pain control the nurse is responsible for advocating for the patient by #1 notifying their supervisor. #2 writing up an incident report and exact quotes for what the doc said "she will have a bad night oh well".

#3 document in the chart EACH phone call made and that the doctor had no new orders. Write the phone # called and the time called back etc.

If this doesn't stop consider contacting the board of medicine in the state or the agency that needs to be aware of this. Inadequate pain relief is tantamount to abuse.

Our total joint and ORIF patients usually have had a spinal or epiduaral pre-op, and they have a PCA post op for a day or 2 with orders for breakthrough pain and nausea. Other orders if no PCA might be MS 2-4mg q 2 hours prn. Some order phenergan, some do not. IM injectable are rarely ordered except by OB docs who still order ancient meds like Dalmane for sleep!

Every patient has a different need.

[crissrn27, RN]

Thanks for the replies! I spoke with my friend recently, and this is continuing. She says she calls several times, and eventually the charge nurse will tell her to stop b/c "he won't do anything, anyway".....I will give her your suggestions, and see if she will do some of them. This almost makes me want to do ortho for awhile, just to help change some stuff!

[Munch]

Wow that doctor needs to take a course on post-op pain management or something. My brother's ACL literally deteriorated and his meniscus was torn(both on the same knee). He had outpatient surgery to repair it and when he was in the PACU he had an epidural and he was fine. Then the epidural wore off and he was in excruciating pain. He had his surgery two weeks after I had my craniotomy(I was inpatient, so he had time to pay attention). He is very opiate naive so after the epidural wore off the nurse brought him percocet(which he's had after root canals so he does know it is pretty weak in comparison to a pretty big knee surgery). He knew right off the bat the percocet wasn't going to cut it so he was his own best advocate, asked the nurse to call his surgeon and he got 2 IV pushes of morphine. He felt much better and ended up sleeping some of the pain off(like I said he's opiate naive) and went home with a script for mobic and percocet 10/523 and that worked well for him while he was at home recovering. But every patient is different(like for me, a chronic pain patient, going home with percocet wouldn't have even made a dent in the pain), while others would do well with vicodin 5/500 during their recovery. Also obviously it depends on the doctor.I believe my brother just needed an IV narcotic to break the cycle of pain, and his doctor had no problem ordering it for him. Other doctors on the other hand could care less about their patients pain and turf them to pain service(which in a busy urban hospital could take hours to get a consult).

[tewdles, RN]

there is no question that too many physcians are far from expert in pain management...he may be a great surgeon but he sux at pain management, and his interpersonal skills seem to be absent. But I bet he makes lots of $$ for the hospital.