Why not let me have a PCA?

[Kim O'Therapy]

I was just wondering about this and was hoping someone could give me an answer.

A few years ago I underwent a total abdominal hysterectomy and oopherectomy. Before the surgery, I requested a PCA in lieu of pain shots. I had ankle reconstruction surgery once and I loved the PCA. Everyone at the hospital told me "its not done that way for hysterectomies." At the time, I was in so much pain, I did not want to argue and I let it go. Now, I'm wondering.....why not let me have a PCA? Thanks for your input.

[debsuztx]

I am so GLAD someone posted this thread. I have been wondering this very same question. I am having a laprascopic hysterectomy this coming Tuesday and will meet with my OB/GYN on Monday to go over my procedure, ask questions, labwork, etc. I'm thinking you don't get a PCA if you have it done laprascopically since its not really cutting on the patient. But, PAIN is PAIN. My friend had a total thyroidectomy two weeks ago, and I went to visit her in the hospital and she had a PCA, and was definitely using it. So, what's the difference?

[GooeyRN, ADN, BSN, CNA, LPN, RN]

In my hospital post op hysterectomy pain is managed with Tylenol and ibuprofen, with maybe a po narcotic thrown in rarely. So mabe they didn't intend to give you IV narcotics.

Yikes! Those poor pts must be in pain! Oh wait, its a "female pain" issue, so its not that bad. I forgot. Sorry. (I forgot that some males think famale pain isn't all that bad and we just like to complain)

[MrsMommaRN]

i had a hyster. and oopher. and had a pca. the problem i ran into was that it was not relieving my pain and even with higher dosing of the pca they had to switch to injectable pain medicaton. i guess it just depends on the prefrence of the surgeon.

[sharann, BSN, RN]

Canoehead. How are those post ops doing? Is their pain controlled well?

The cut they make is still a big one where I work.

What does a bowel resection patient get at your place? A Chole? An appy?

That sounds like undermedicating to me unless your surgeons are super talented! A circumcision gets tylenol with codeine to take home...

[kamakasigirl]

I had an emergency c-section and was only offered IB 600mgs painful memories coming back..................

[Otessa, BSN, RN]

It's normally the surgeon that determines a PCAs ordering or not. A plan before surgery is imperative for a patient regarding pain control.

[ortess1971]

I need to have an E.C.C.(endo cervical curretting) done and I am considering going to another doc- not because he doesn't know what he's doing or he's rude or anything but because he told me that he likes to do his Leep Cone biopsies in the office. I have talked to nurse friends that had it done in office and they said it was excruciating. Sorry, but at my hospital, some docs do vasectomies under GENERAL anesthesia. Why are female procedures given the short end of the stick? I already told this guy that I will NOT have the Leep in the office and I expect to have adequate pain control for the ECC. Ps Also most of the other GYN docs do the Leeps under general anesthesia-there's got to be a reason why!

[Marie_LPN, RN, LPN, RN]

We have quite a few pts. who get LEEPs done under local, who have said "wow that wasn't as bad as i thought it was going to be."

All of our cold knife cones ae done under general, though.

And i've always seen D and C's done under general, only see D and E's done as mod sed when the woman is breastfeeding and has requested as little "drugs" as possible.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

We have quite a few pts. who get LEEPs done under local, who have said "wow that wasn't as bad as i thought it was going to be."

All of our cold knife cones ae done under general, though.

And i've always seen D and C's done under general, only see D and E's done as mod sed when the woman is breastfeeding and has requested as little "drugs" as possible.

I had a LEEP done under local and it was not bad at all. It felt like I was being electrocuted but, for only for a few seconds. I was only a bit sore afterwards, but didn't warrant taking tylenol even. I drove myself home, and then went for a 3 mile hike. I guess everyone is different.

[Marie_LPN, RN, LPN, RN]

Our docs are constantly asking the pt. "Are you OK? You let me know if anything hurts at all" and always tell the pt. what they're going to do before the procedure, and then tell the pt. what they're doing during the procedure. I think that (and the lidocaine, obviously) has a lot to do with why our local LEEPs go so smoothly.

[Kim O'Therapy, BSN, RN]

Thanks for your replies everyone. I feel justified now. I would love to ask the surgeon, but he is retired now. The surgery was about three years ago. Looking back, I think that I was very intimidated at the time. I was "weak" due to the length of my illness, the pain involved, and desperate. This was a "well known" hospital and the surgeon was also a Harvard professor - so I felt intimidated. Plus, I asked the CRNA, the anestesiologist, the resident MD that checked in on me, and the floor nurse about using a PCA - all had the same "no" answer. Anyway, they did keep my pain under control with shots in my hip that left a real nice bruise. I don't mind shots, but when you have a huge incision across your belly, you don't feel like rolling over for a shot. Again, thank you for your input.

[all4schwa]

i had LEEP with local, in the office--not too bad, not sore after. had cone biopsies with nothing and was v.uncomfortable!! of course that was before the LEEP or I would have known the ask for something locally!

this gives us all a lesson- in the future, pain control will be discussed before anyone is given permission to cut on me!