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

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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.

Wow, and I thought I gave some high doses during burn dressings!

Imagine what the cost of meds must look like on that hospital bill. Hopefully the pharmacy dept is well stocked.

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Fentanyl patches totaling 650 mg., changed every 2 days rather than 3. Well, actually, the person had been on 600 mg. for quite awhile and had needed break through po meds. She spoke her MD and together they decided to increase the patches knowing that it might be overwhelming. She was tired of the pain and ready to go. She died within 24 hours of the increase. Did the increase do it? Perhaps, but I was there at the time she became comatose and her respirations were not diminished. I like to think it was her time and the increase just made the passing easier.:nurse:

if she was on 600 mcgs for awhile, then the increase did not cause her death, i can assure you.

she said she was ready, and by golly, she meant it.:)

leslie

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Thanks, I did need to read that. I knew in my heart it was OK (I did mean mcg. by the way) but our pharmacy really was placed under great scrutiny after this experience.

They questioned us about narcs. a lot after this time. I don't know if they believed that there was diversion or just CYA but it was annoying to have to justify MD decisions to them. They claimed they were too short staffed to spend much time investigating dosages with MDs. This was in a LTC, not hospice situation, by the way. Like we were not short staffed!:bow:

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Specializes in Cardiac Telemetry/PCU, SNF.

No way I'll win, but I'll throw mine in:

Dilaudid PCA at 8mg basal w/1mg q10 min (yes folks, 14mg/hr)

2 Fentanyl lollies q6

100mg Phenergan q6

It was impressive. Nothing says good buzz like drooling with a Fentanyl lollie hanging out of your mouth! Then they would wake up causing a ruckus about being in pain. Was a master manipulator though, took the IV off to take a shower for 30 minutes and was doing OK, then as soon as the doc hit the floor, they started writhing and screaming in pain. Luckily, they weren't mine!

Tom

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Specializes in Infection Preventionist/ Occ Health.

When I worked inpatient peds hematology, I had some pretty young adolescents on HUGE doses of morphine or hydromorphone via PCA. One guy had to have a special concentration of morphine prepared (5 mg/1 ml versus the normal 1 mg/1 ml) because otherwise we were changing the bag multiple times per day. I think his dose was 10 mg q 10 minutes on a PCA- something crazy like that. He was still up and talking.

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Specializes in Hospice.
So far, I think you're winning.

Actually ... it's a not-very-close second. Back in 1975, I was reading one of the early texts on pain management. The author (McCaffrey?) cited a case of a young man getting over 1500 mg of MSO4/hr and was not only awake, but walking around!!!

Opioids are truly all about context, tolerance and assessment. Numbers are meaningless.

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