What's the most pain meds you've ever seen ordered?

[blondy2061h, MSN, RN]

I've seen some pretty generous pain med orders, but two come to mind that take the prize. I will say that both of these patients had conditions that are well known to be painful, and I have no doubt at all that they were in honest-to-god pain, but I still think both were a tad over the top.

1) Methadone PCA= 8mg/hr basal, 4mg q10min bolus. Also on other PO pain meds.

2) Dilaudid 6mg q1hr prn, in addition to a fentanyl patch, and an epidural morphine & baclofen pump. I kid you not.

[icyounurse, BSN, RN]

One time working in recovery room, had patient come out from back surgery, no tolerance for any kind of pain, on a pharmacies worth of meds at home, after anesthesia gave 10 mg morphine iv,I gave him:

additional 10 mg morphine ivp

50 mg demerol ivp

25 mg phenergan ivp

2 mg dilaudid ivp

po methadone 80 mg

and then, after many distressed calls to anesthesia(pt literally screaming non stop, disturbing every other pt in recovery, family irate that pt doesnt have proper pain control)

ANOTHER 2 mg dilaudid ivp.

This was all within 2 hours time. I couldnt believe the man was even still breathing, much less screaming after all this. Docs were REALLY familiar with him and sent him to the floor like this, yelling the whole way. Floor nurses also were very familiar with pt and family when he arrived. Made me glad I was not working the floor that day.

[icyounurse, BSN, RN]

Oh I forgot to mention, he was also on dilaudid pca. Jeez. It really amazed me to see all those meds go into someone's system at once and to never even get sleepy. I think about 1/2 of that amount of meds would have killed me nearly instantly.

[RN1982]

Can we stretch this to continuous sedation. I had a patient on 220mcg of Fentanyl and 15mg of versed...still didn't touch him.

[ShayRN]

Hospice patient with a history of drug abuse. Morphine Sulfate IV 155mg/hour and she was sitting up talking.

[RN1982]

Nuh uh...???

[blondy2061h, MSN, RN]

Hospice patient with a history of drug abuse. Morphine Sulfate IV 155mg/hour and she was sitting up talking.

Wow, I think you may win this.

[ShayRN]

I know, I was surprised myself. Dr. G says that MS doesn't have a ceiling. When your body builds up a tolerance you just go up on it. I use to be afraid to give 2-4mg IV, now it is like peeing in an ocean, ROFL.

[BlueTexas89]

Hospice patient with a history of drug abuse. Morphine Sulfate IV 155mg/hour and she was sitting up talking.

I know, I was surprised myself. Dr. G says that MS doesn't have a ceiling. When your body builds up a tolerance you just go up on it. I use to be afraid to give 2-4mg IV, now it is like peeing in an ocean, ROFL.

geeez, 1mg MS would knock me out cold!! thats insane for 155mg/hr. i definitely would become comatose! haha

[icyounurse, BSN, RN]

Hospice patient with a history of drug abuse. Morphine Sulfate IV 155mg/hour and she was sitting up talking.

Wow!!

That seems incompatible with life for most people.

And I thought 20 mg IV was alot.

[RazorbackRN, BSN, RN]

I've given 300-400 mcg Fentanyl q 15min along with Morphine 10-15mg and 2-3 mg Versed, with a background of Oxycodone 10mg.

This was during my days in the Burn Unit.

I still don't know that this beats the 155mg Morphine though!

[rph3664]

I know, I was surprised myself. Dr. G says that MS doesn't have a ceiling. When your body builds up a tolerance you just go up on it. I use to be afraid to give 2-4mg IV, now it is like peeing in an ocean, ROFL.

On two occasions, I have seen hospice patients on morphine, 200mg/hour continuous drip.

We just pulled it out of the vial and put it in a bag without diluting it.