What is the pain med of choice?

[hdhnurse]

I have been a nurse for 11 years and in the past year or two I have noticed that we are giving more and more Dilaudid IV for complaints of pain. It doesn't matter what kind of pain, the house doc just orders Dilaudid 1-2 mg IVP Q 2 hr for pain.

Is this happening at your facility? Why the switch from morphine to dialaudid....It is causing a lot of problems for us because the drug seekers are coming out of the woodwork with "abd pain" to get Dilaudid.

We have had to narcan several patients due to over sedation. But if you don't give them Dilaudid they throw a fit. They are now asking for this drug specifically when they come in.

I personally went into nursing to take care of sick people not to be a drug pusher.

So what are thoughts on this? I am afraid that someone is going to get hurt if one of our "druggies" go off the deep end.

[RNsRWe, ASN, RN]

What burns my butt is when the hospitalists admit everyone under the sun for abdominal pain-nausea-vomiting, prescribe Dilaudid 2mg q2h IVP for the person who is sneaking snacks and laughing on the cell phone all night, and then give us a hard time about getting Dilaudid or morphine for someone who is WRITHING in pain. What, afraid you might run out of the hospital supply for the druggies you admit every day??

You got pain, I'm going to do my best to kill it. You give us a BS set of symptoms to get admitted for your q2h fixes, I have no use for you. Period.

[lpnstudentin2010, LPN]

You might start having a problem getting that particular drug. Our hospital no longer carries it as formulary, only as a last-resort med when the patient is allergic to EVERY other option possible. This is the way in LOTS of hospitals now...something about how the toxic effects of this med outweigh the benefits, and docs don't want to be caught prescribing it. And pharmacy has told our nurses that if they give it without questioning exactly why something else (anything else) could be given, we could be hung out with the doc for the consequences.

Since this directive came down, we've found other options, none of which are Demerol, and all of which seemed to work.

I hope that doesnt happen at my hospital. I dont even really need it for pain normally (though it is nice to make sure I will not have pain). It is what calms me down.

When I wake up I am aggitated, unable to lie still, and bawling by eyes out for no good reason. I found out by accident that it calmed me because at one of the surgeries the nurses kept asking me was i in pain because I was FREAKING OUT. Flailing around, rolling around in the bed, crying my eyes out, i remember it a bit and it was bad. Finally I said yes to make them stop asking me (about the pain), I calmed right down. Now I inform my anesthesiologists of this affect of anesthesia, and how I have noticed that demeral seems to calm me. and let them make their own minds out. I have never been told no.

[RNsRWe, ASN, RN]

I hope that doesnt happen at my hospital. I dont even really need it for pain normally (though it is nice to make sure I will not have pain). It is what calms me down.

When I wake up I am aggitated, unable to lie still, and bawling by eyes out for no good reason. I found out by accident that it calmed me because at one of the surgeries the nurses kept asking me was i in pain because I was FREAKING OUT. Flailing around, rolling around in the bed, crying my eyes out, i remember it a bit and it was bad. Finally I said yes to make them stop asking me (about the pain), I calmed right down. Now I inform my anesthesiologists of this affect of anesthesia, and how I have noticed that demeral seems to calm me. and let them make their own minds out. I have never been told no.

Sounds like you're an unusual Demerol patient, but I figured I'd just let you know that it does appear that "the end is near" for that particular drug. Here's probably a silly question at this point, but why were you not given Ativan or Xanax for what sounds like severe anxiety? Demerol should not be used for that, but there ARE good anti-anxiety meds...?

[lpnstudentin2010, LPN]

Sounds like you're an unusual Demerol patient, but I figured I'd just let you know that it does appear that "the end is near" for that particular drug. Here's probably a silly question at this point, but why were you not given Ativan or Xanax for what sounds like severe anxiety? Demerol should not be used for that, but there ARE good anti-anxiety meds...?

I was actually thinking about that, and spoke with my psychiatrist about it. That is what he said to, but I do not know how to handle that when it comes to surgery. I do not ask them for the demeral I just tell them the pattern I have noticed. I feel like asking for a specific drug first off does look like a drug seeker, and also looks like I am trying to tell them how to do their job, which I do not want to do, because they know what they are doing. I definitally would perfer to not take pain meds if I do not need them, but I dont know how to handle it with getting the other.

[leslie :-D]

i find demerol to be very effective...

but it has caused too many apneic periods for my pts, regardless of dose.

we have it on board, but seldom use it anymore.

we use a lot of methadone.

leslie

[RNsRWe, ASN, RN]

I was actually thinking about that, and spoke with my psychiatrist about it. That is what he said to, but I do not know how to handle that when it comes to surgery. I do not ask them for the demeral I just tell them the pattern I have noticed. I feel like asking for a specific drug first off does look like a drug seeker, and also looks like I am trying to tell them how to do their job, which I do not want to do, because they know what they are doing. I definitally would perfer to not take pain meds if I do not need them, but I dont know how to handle it with getting the other.

Hmm. Well, I guess if I were in your shoes, if I KNEW I'd be having a surgery shortly, I'd be talking with the doctor who would be handling my meds and treatment once I got to the floor. The anestheseologist won't want to know about it, and MAYBE the surgeon, if that surgeon is the one who will be writing the orders for you after PACU. Is this the case? If it is, talk with him/her before you go in for the surgery, and ask for something for what amounts to a severe anxiety attack post-op. It can be either PO or IV, depending on what you're having done, etc. and can be PRN or scheduled. Talk with him! :)

[lpnstudentin2010, LPN]

Hmm. Well, I guess if I were in your shoes, if I KNEW I'd be having a surgery shortly, I'd be talking with the doctor who would be handling my meds and treatment once I got to the floor. The anestheseologist won't want to know about it, and MAYBE the surgeon, if that surgeon is the one who will be writing the orders for you after PACU. Is this the case? If it is, talk with him/her before you go in for the surgery, and ask for something for what amounts to a severe anxiety attack post-op. It can be either PO or IV, depending on what you're having done, etc. and can be PRN or scheduled. Talk with him! :)

Is it the anesthisiologist for the pacu though? the surgery I am having soon is day surgery, and it is only as I wake up anyway. So who would I talk to about that.

[RNsRWe, ASN, RN]

Is it the anesthisiologist for the pacu though? the surgery I am having soon is day surgery, and it is only as I wake up anyway. So who would I talk to about that.

Ah, day surgery--not my forte! I work on a post-surgical floor. Well, I guess it'd be the anesthesiologist, if he's the only one who is prescribing the pain relief you'd be getting after the procedure, and before discharge. You need to talk to him before surgery, right? So I guess I'd run it by him. Maybe someone here who regularly works in ambulatory surgery would know better? Just seems that you must have a better option available to you than Demerol, especially since it's not for pain relief!

[lpnstudentin2010, LPN]

Ah, day surgery--not my forte! I work on a post-surgical floor. Well, I guess it'd be the anesthesiologist, if he's the only one who is prescribing the pain relief you'd be getting after the procedure, and before discharge. You need to talk to him before surgery, right? So I guess I'd run it by him. Maybe someone here who regularly works in ambulatory surgery would know better? Just seems that you must have a better option available to you than Demerol, especially since it's not for pain relief!

I have DEFINATILLY been thinking the same thing, but did not know what to do about it.