Post total hip/knee pain management

Hi,

As I work in the recovery room I don't see the patients a day or 2 later. My question is: What do your ortho docs use for pain control? We have a couple different physicians who use PCA's, while a couple use a "cocktail" of narcotics, steroids, and NSAID's. Which of these approaches do you feel work better for MOST(not all of course). Thanks!

I am just a Tech still but I do work on the orthopedic floor of a hospital. I have found that after almost every total hip or total knee surgery, they come up with a Morphine PCA and keep that for the first day or two. After that they usually get a strong pain pill such as Vicodin or Darvocet. This is just what I have observed.

I think that the Morphine PCA works best because it keeps their pain controlled best. But the only downfall is that the next day when we get them up for physical therapy, they sometimes get sick from the morphine.

[VivaLasViejas, ASN, RN]

Where I work, the surgeons usually order PCA morphine and Toradol for the first day or two post-op, which provide good pain control for the most part. A couple like to use epidurals, which are usually either very good or terrible.....personally, I hate 'em, because they require such frequent monitoring, especially when you have to titrate. But if it works for the patient, that's all I really care about......far better for him/her to have complete pain relief than for me to have a couple of minutes to do something else. :)

fresh post-ops either have a PCA (usually morphine, 1.5 mg bolus with a 6 min. lockout is our standard dose) or an order for IVPB morphine (2.5-10 mg q 3-4 h)...

within 2-3 days we wean them down to Percocet (1-2 tabs q 4-6 h)... and then they're weaned down to Tylenol 3's (1-2 tabs q 4-6 h)...

our ortho docs are TOTALLY against giving any sort of NSAID...

i find the PCA's to be the best because, for most, the pain control is more constant... so they get up and move a lot better... of course, since a lot of our ortho patients are frail elderly, there are concerns of over medicating them... and a lot of people are hesitant to give up their PCA because it is so effective for their pain control...

ETA: we also get epidural PCA's (mostly hydromorph, either with or without a local)... i don't find them as effective for most people... it can be too hit or miss with getting the block in the right area and i often find it's too much or too little pain control...

Where i work we use morphine pca with ondansetron intravenously for nausea for 1 to 2 days depending on the individual, then on to tramadol tailored to the patients symptomns,this works well for most people and they have the option of oramorph for breakthrough pain.When the patients are discharged they are normally on paracetamol and tramadol and the gp or district nurse reviews their pain management in a week.:rotfl:

Where I work the main Ortho doctor has a general list of meds he gives all his patient. This doctor usually has Dilaudid SQ to be given with fresh prost op and then they are weaned to Percocets or Lortab. The other ortho doctors usually use the Morphine PCA for fresh post op.

Thanks for the input everyone. Happy Thanksgiving.

Our orthodocs having personal order sets for their total knees or total hips.

also often use PCA's one to two days post op in combination with oral analgesia then move onto oral analgesia with IM morphine/pethidine charted for breakthru pain. never come back from PACU with epidurals still infusing in PCA form or otherwise and never use NSAID's.