Post-op Vag hyst patient with thigh pains

[sharann, BSN, RN]

I had a post Vag hyst yesturday who was quite distressed over bilateral thigh leg and back pain after surgery. I am assuming this is related to the operative (Lithotomy?) position used during. Is this avoidable. I documented this of course, and the pain eased with a few doses of narcotic, but I was wondering if this is common? I would love comments from both OR and PACU nurses. Thanks.

[Marie_LPN, RN, LPN, RN]

I've heard arthritic pts complain afterwards, but it usually subsides after 30 minutes of having the legs down.

It also depends on the stirrups used during the case (Allen's, also known as Yellowfins have the legs in regular lithotomy, or candy cane D and C stirrups the legs are high lithotomy).

Where in the back are they complaining of pain? I've noticed if the buttocks hang off the edge of the table a little more than they should, it flexes the back, which can create lower back pain.

Any of thses pains could also be attributed to a peson's lifestyle as well. If they aren't used to bending like that awake, then spending a couple of hours like that can do it.

[Marie_LPN, RN, LPN, RN]

And also, continue documenting. If this is routinely happening, a change is needed.

[grimmy, RN]

i'm hoping that the pt had anti-embolic stockings and kendall boots on, too (or did they use enoxaparin?) lack of blood flow, poor positioning, can all contribute to that sort of pain - what type of lithotomy positioning did they use? candy canes or yellowfins? i think they make a difference. it also matters when the pt is obese - there's a lot of pressure on the feet, back, and backs of the legs when an obese person is in lithotomy for extended periods of time. part of the cost of "doing business," i'm afraid.

[VivaLasViejas, ASN, RN]

You know, I've wondered about that too........I floated to OB-GYN a lot when I was a hospital nurse, and vag hyst patients were almost universally painful post-op. I wonder if doctors ever really warn patients about how much they're going to hurt afterwards? They make it sound like such a simple procedure, and patients almost always go home the next day, but those first few hours after surgery are exceedingly uncomfortable. And if I've heard one woman complain about post-op pain, I've heard them all---they say "I never thought it would hurt this bad!!"

I can see where positioning might be an issue; there's probably some nerve impingement involved. Last night I spent about an hour and a half in candy cane stirrups having a ureteroscopic laser lithotripsy, and today my thighs ache ferociously......I bet it does have something to do with being in the dead-bug position on the table:chuckle

[sharann, BSN, RN]

Thanks for the replies. I don't believe that they use any sort of anti-embolic stocking during procedures on any gyne procedures, or Lovenox. I wondered about this as well. I will ask the OR staff next time what type of position devices used. Yellow Tail or candy cane did you say? Are these types of stirrups? This patient was fairly younfg and not obese by the way.

[Marie_LPN, RN, LPN, RN]

Yellowfin (also known as Allen's ) and 'candy cane" (also known as D and C stirrups). I'll try to find links for each.

[Marie_LPN, RN, LPN, RN]

Yellowfins picture:

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Candy Canes:

[DutchgirlRN, ASN, RN]

I've had a D&C x 2 and oh brother did I ache afterwards. I felt as though I had been pulled all different directions, definately muscle related pains, I attributed it to positioning and to being pulled on and off the table. I'm 250 pounds, although after other surgeries I never had that "oh I've been pulled on feeling". I'm sure I was transferred with a turn sheet and I'm sure several people were involved. Interesting.

A HH patient of mine had a GYN procedure, c/o leg pain post-op, no TEDS/SCDS used, no Lovenox, hx of clotting disorder and ended up with a BKA.

[sharann, BSN, RN]

Thanks Marie. They have used Candy canes in the past, I recognize them! I have never seen the Yellow fins. Our hospital sort of has a dark ages OR. It needs new equipment. Working in PACU is o.k now since we have come into the 20th(not 21st) century.

[Marie_LPN, RN, LPN, RN]

I love the Allens. They are much gentler to the pt's feet, the legs do not move unless you move the stirrup, plus you don't have legs that are swinging in the breeze.

Quite honestly, for any gyn procedure, i'll request they are used on me.