What are you "go to" pain meds for outpatient surgery?

[jenlynnrn]

I just started a new job at this ambulatory surgery center, but there is no fentanyl, is this normal. They use demerol and dilaudid, anyone have any info on why these may be better. OH also, in the recovery room nobody uses a stethoscope...ever! I brought mine in all ready to use it and it ended up in my purse all day, even patients that came out with LMAs no airway check besides the pulse ox, this is the 3rd center i have worked at and 1st time with no stethoscope.

[brownbook]

We use demerol once in a while if the patient is shaking after surgery. And once in a while demerol IM for long term pain relief. I have heard vague rumors that demerol can have odd side effects (I saw this once, patient had kind of like seizure activity after IV demerol) and how long demerol's effects last can really vary. But my knowledge is more vague nursing rumors, not fact based.

We don't use dilaudid alot. I know it is very strong, I haven't given it, other nurses have if their patient is having a lot of post op pain and fentanyl and morphine aren't working.

We are having a hard time getting fentanyl with this drug shortage that is affecting the country. Perhaps that is the reason your clinic isn't using it?

I would ask why they don't use fentanyl?

As to stethescopes. There is no reason you can not, should not, use yours. If the patient comes out of OR sitting up, talking to anesthesia about their golf game, O2 sats are 100 % room air you may get some odd looks from co-workers if you do a full lung sound assessment.

I don't use stethescopes a lot. But we keep several close by the nurses station. If I am getting a pediatric patient, and or based on the patients surgery or report from OR about the patient. I get one ready to use.

[OralSurgeryRN]

I agree that the Fentanyl may be due to shortages but also, each doctor uses what they are comfortable with. I have one surgeon who likes Fent/Versed and one who likes Demerol/Valium.....until a coworker and I did a QI study and found that our Demerol and Valium patients had longer recovery times and more instances of post-op n/v.

I work in an Oral Surgeon's office and I evaluate lung sounds both before and after surgery. I have actually caught patients with severe bronchitis/pneumonia in pre-op. Also had a couple of patients with wheezing after surgery and found out they had undisclosed asthma. You are always better to assess and get normal than not to assess and end up with problems!

[BBQ RN]

Our PACU uses demerol/fentanyl/Versed/dilaudid/morphine. Our ACU unit uses dilaudid/norco/morphine once they're more awake. PACU nurses don't carry stethescopes normally. On ACU, I'm one of the only nurses that wears mine, otherwise we keep them on the vital machines.