Pain management

[mandaaRN]

I'm having a difficult time understanding how to control pain in post-op patients. Last night my patient was on a PcA pump for the first 15 minutes of my shift, then was d/c'd. There were orders for 4mg IV morphine q4h, 1mg dilaudid IV q4h, Percocet 2tab q4h, and Vicodin 1tab (unsure of frequency). My question is, how am I supposed to choose which is best an how do I wean the patient off of IV pain meds? I started with the 4mg morphine initially since she was a fresh post op and informed the pt I would be weaning her down to PO. I thought I knew what I was talking about and decided to give IV dilaudid this morning. Stupid me didn't realize dilaudid is 10x stronger than morphine. The next nurse coming on told me that 1mg of dilaudid is like giving 10mg of morphine. Wow, well lesson learned there. Pt was fine, no harm. But can someone help me understand how I would wean off iv pain med and so forth? I'm fairly new and not that familiar with post op, I'm used to the chronic drug seeking frequent flyers, therefore pain management was just a slight issue for me. :/ I feel so dumb!

[Sun0408, ASN, RN]

Wouldn't you want to worry about the peak of the PO occurring at the time of IV onset?

Simple answer No.. I already explained IV is fast acting and doesn't last long. PO takes a while to become effect but lasts much longer.. So a little IV now with PO keeps the pain at a tolerable level for the post-op pt.