Transcript Post-Operative Pain Control

“Early to Rise, Early to Home”
Standing Patients on Day of Surgery
Trish Davidson, PT
Langley Memorial Hospital
Mobilizing Patients on Day 0
• Communicate plans with
nursing staff
• Physiotherapist: Altered
hours of work for the last 3
months
• Transfer/mobilize patients:
with RN/LPN instead of
PTA
Mobilizing Patients on Day 0
• Developed criteria for
safely mobilizing patients
on Day 0
• PO Day 1: get patients up
closer to lunch time
• Book patients 60 days in
advance of surgery
Post-Operative Pain
Control
Langley Memorial Hospital
Non-narcotic analgesic
Multi-modal approach
Narcotics
Sustained Release
•ATC
Immediate Release
•PRN
Nonsteroidal anti-inflammatory
Non-narcotic analgesic
Acetaminophen
□ 650 mg po q6h X 72 hrs then change to 650
mg po q4-6h PRN
□ 975 mg po q6h X 72 hrs the change to
975 mg po q6h PRN
□ 650 mg suppository pr q6h X 72 hrs then
change to 650 mg pr q4-6 h PRN
Nonsteroidal anti-inflammatory
Celecoxib OR Diclofenac
□ Celecoxib 200 mg po daily X 3 days
(contraindicated in SULFA allergy)
□ Diclofenac 50 mg po q8h X 3 days (may give
first dose PR
□ Diclofenac 50 mg pr q12h X 3 days
Sustained Release Preparation
□ OXYCOCONE SR 10 mg po q12h (if less
than 60 kg or opioid sensitive) – if necessary
after 18 hours may increase to 20 mg q12h
OR
□ OXYCODONE SR 20 mg po q12h – if
necessary after 18 hours may increase to 30 mg
q12h
Sustained Release Preparation
□ HYDROMORPHONE SR 3 mg po q12h
(if less than 60 kg or opioid sensitive)
OR
□ HYDROMORPHONE SR 6 mg po q12h –
if necessary after 18 hours may increase to 9 mg
po q12h
Breakthrough Analgesia
□ Oxycodone immediate release 5 – 10 mg po q3 – 4
h prn for Break Through Pain (BTP) – if less than 60
kg or opioid sensitie
□ Oxycodone immediate release 10 – 20 mg po q3-4h
prn for BTP
□ Hydromorphone immediate release 1 – 2 mg po
q4h prn for BTP – if less than 60 kg or opiod sensitive
□ Hydromorphone immediate release 1 – 4 mg po
q4h prm for BTP if > 60 kg
Advantages to Oxycodone SR

Around the Clock (ATC) Dosing
 prevents pain
 maintains a pain rating that is satisfactory to the
patient
 maintains a stable analgesic blood level
 based on the knowledge that less drug is needed to
prevent the recurrence of pain than to relieve it
 prevents the undertreatment of pain in patients who
are hesitant to request medication
 eliminates delays patients encounter waiting for
caregivers to prepare and administer pain medication
Advantages to Oxycodone SR
 Reduced incidence of nausea and vomiting
 Reduced need for antiemetics
 Oral administration
 I.V. can be discontinued or converted to a saline lock
– one less hindrance to mobilization
Adjustments to the Regime
 Medications ordered q12h are automatically given at
1100 and 2200
 ↑ need for PRN medications
 Rapid response from anesthesiology resulted in specific
direction to administer the Oxycodone SR at 0800 and
2000 hours
Pain – the fifth vital sign
• A study in which 353 hospitalized patients were
experiencing pain
• Fewer than half the patients with pain (45%)
had a member of the health care team ask them
about their paitn or not it in the record
Donovan, Dillon, McGuire 1987
Pain – the fifth vital sign
• A study of 242 hospitalized patients with pain, a
review of their records revealed that no
assessments of pain intensity were documented
by any caregiver.
Gu, Belgrade 1993
Discharge Pain Regime
Why change what is working?