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Old 06-08-2006, 10:11 AM   #1
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Post op pain care

I think the subject has come up a few times but at anyrate. I'll be having a hip revision in about a month and was wondering about post op pain meds. I am currently on 120mg of MScontin (pain doctor just upped it yesterday from 90mg) a day.

I am concerned about immediate post op care. The doctor operating said he will be calling the PM to find out what his protocol was. The PM didn't get into specific details but said I'd be on my regular morphine and then he'd probably add something for break through such as Vicodin(I don't have bt meds). I am supposed to go see him before my surgery to have medication in place for when I'm released from the hospital but he honestly didn't go into specifics regarding while I am in the hospital.

My concern is right now the current meds don't reduce the pain by much and I am concerned as to what will happen post op if there's no change or little change in meds. It's a major surgery and I know how bad it was the first time I don't want to suffer again like that, of course this surgery isn't as intensive but still surgery none the less.

What have you all done in the past? Are there any questions I should be asking the PM and the Orthopeadic surgeon? I honestly am not sure what to expect because I've not been in PM care during any of my other surgeries so this is new for me.

thanks for your time

Barbie

 
Old 06-08-2006, 11:15 AM   #2
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Re: Post op pain care

Hey Kissa,

As far as immediate post-op meds in the hospital, they should be giving you IV/IM meds like Morphine or Dilaudid while they get your pain under control.

Many times in the hospital they will get you switched over to oral meds to see how your pain is. But I would tell your PM doc know how your pain is, because you will have to account for acute pain after the surgery.

You may either need an increase in your LA med, or a strong enough BT med like Percocet or Dilaudid for the acute pain and BT pain.

Either way, make sure you get it squared away with the doc now, before your surgery.

Hope your surgery goes well and you can get your meds straightened out.
Take Care

 
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Old 06-09-2006, 05:45 AM   #3
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Re: Post op pain care

Hi Kissa - Exactly what are they going to do? I've been through 3 hip operations and can totally relate to the question of: How do you treat the post surgical pain when you're already taking a high dose of pre-operative meds? I agree that you need to talk to the doctor who will be in charge of your post op pain care and be very, very specific about how your pain will be controlled. Even though I thought I had all my bases covered by talking to the anasthesiologist (sp?) and my surgeon, I ended up with NO extra pain meds after surgery, just my normal 180 mg. of methadone and 8-12 mg. of dilaudid for breakthrough pain. I know that sounds like quite a bit of medicine, but if that's what your body is used to for everyday pain control, imagine how it feels after a hip replacement when nothing is added to the mix! What I have found most helpful is some form of self injectible pain medication (fentanyl, dilaudid, etc.) that is set to be infused at a particular rate per hour AND at other times when the patient feels they need more. I think it's called a PCA (patient controlled anasthesia). But the bottom line is communication BEFORE surgery. The last thing you want to be doing is negotiating for pain meds when you're at a 12 on the 1-10 pain scale in the recovery room. You're on my good wishes list Kissa! Don't forget to respond and answer my questions about the hip surgery - KathyMac

 
Old 06-09-2006, 08:56 AM   #4
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Re: Post op pain care

What happened to you is exactly fear Kathy. I am only having the liner and ball replaced, the cup appears to be fine and the stem is stable.

He is fully aware of the pain I'm in as it's been increasing over the months and we tried a few things to get it under control without sucess. I did breifly talk to the PM on Weds and he did increase my morphine from 30 mg three times a day to 60 mgs twice a day. It seemed weird at first because I was used to taking meds every 8 hours but the small jump seems to be helping much better than the 90 was alone. Believe it or not the MSC actually appears to be working longer in the 60mg than it was with the 30. I was pretty worried at first but it appears just fine. I go through a small period of pain but it's not like it was when I was taking the 30's instead.

I figured there'd be an IV pump would be used, at least I'm hoping. I'm allergic to Fentanyl so it will have to be morphine. When I had my first total hip replacement I was on a morphine pump for a few days then they changed the meds and gradually dosed me off of it the week I was there. When I was at the rehab I was on 2 vicodin every 3 hours and was sent home with.. get ready it's a big one.. Darvocet! Back then the meds actually helped because I was on nothing stronger prior to the surgery.

The PM did say to definately see him before I have the surgery so he can give me medications for when I come home and I'll rediscuss the in stay care with him then. The surgeon will be calling the PM to see what protocol he wants used. I am quite sensitive to certain medications so there's only a handful that I can even take before I break out in hives or have severe insomnia.

Kathy were the ones you had total's or were a few of them partials and how long were you in the hospital for and did you go to rehab after. It's been 13 years since my last one so lots have changed

thanks!
Barbie

 
Old 06-09-2006, 07:02 PM   #5
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Re: Post op pain care

Hi Barbie - My history is complicated because of my oteoporosis and my tendency to get infections. I broke my right hip last May (2005) spontaneously. I actually think that I did it while mowing the grass one day, but I'm not sure. Anyway, I walked on it for a good 2-3 weeks before the pain became intolerable and my hubbie took me to the hospital e.r. It was a pretty bad break and they operated to give me a total hip replacement. I was in the hospital for about 1 week and then went to a rehab for about 7 days. I was kicked out of their because my surgeon didn't want me to put any weight thru my right hip/leg/foot for at least 5 weeks and Medicare wouldn't pay for a stay in rhab without any goals being met. So I went home. About 2 weeks home I spontaneously broke my right femur which caused the hip replacement & all the hardware to "fall" into the femur space. Back I went for another revision plus reduction of the femur fracture. After about 3 weeks home I became severely infected with MRSA, a very common germ that lives and thrives in hospitals. It had gotten into my surgical site, into my blood stream and travelled throughout my organs, including my heart. Well...I was a very sick person and back in the hospital for the entire month of August 2005 and the first week in September. They removed my hip and inserted a Groshon (sp?) catheter in my chest so I could receive vancomcyn 24/7. I was released with the catheter and continued to get my antibiotic through the catheter until December of 2005. I didn't get a new hip until this past March. I am just now starting to feel like I'm on the upswing!! My doc finally ordered outpatient p.t. 2 weeks ago and I'm able to drive now for short distances. I'm out of my wheelchair most of the time and can walk with crutches. My pain management doc has me titrating down on my pain meds, methadone and oxycodone, while he ups my topomax. I hope I've answered your questions...but I probably just rambled on and on. KathyMac

 
Old 06-10-2006, 11:39 AM   #6
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Re: Post op pain care

Hi Kathy,

you sure have been through a lot in such a short period of time. I can understand the infection issue as the same happened to me as a child (I think I previously mentioned that) and I too ended up in the hospital where they removed all my hardware and in patient for over a month.

Fortunately this time the stem isn't going to be replaced and as far as I know the cup will not be either so that should help some with healing because technically no bone should be removed.

I made a list of about 20 different questions to ask the surgeon when he calls next week. I just want to be sure I have a good understanding of what he's doing and how it will impact me vs the THR. I'm sure there'll be limitations on what I can do like no bending etc.

Do they still use that big triangle or V shaped pillow that gets placed between your legs so your hip doesn't roll in when you sleep? I had to use that thing for about 6 or so weeks and it about drove me nuts!

 
Old 06-11-2006, 01:53 PM   #7
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Re: Post op pain care

Hahaha - yes - you will get your own personal WEDGE to stick between your thighs. They don't want you breaking hip precautions, do they?? As soon as I could pitch that thing off of me, it was gone!! But, it really is a good idea to use it for awhile to help remind you about not crossing your legs, etc. Almost all the normal body movements we perform without even thinking about them are the ones that seem to break the hip precautions!!! It made me nutty trying to remember: no BLT's: no bending, no lifting, no twisting! At this stage in my life....with all the set-backs, etc., I really try and pay attention to all the rules now. I'll be watching for your progress! KathyMac

 
Old 06-11-2006, 07:13 PM   #8
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Re: Post op pain care

Oh yippee I get a brand spanking new hip wedge! LOL just kidding. My cats will probably think it's a new pillow for them to sleep on with their mommy!

What's hard for me is I don't sleep on my back so well so I have to sleep on my good side with a pillow between my legs. I've slept like that since I had the first hip surgery back in 1974. It drove me insane the first week or two in the hospital after the replacement in 93 because I so badly wanted to lay on my side. It will definateley take some adjusting that's for sure.

We're also talking about rearanging the bedroom some so it's easier for me to get in and out of bed and to our bathroom. Right now I just have a small space between me and the closets and there's no way a walker will fit in that tight spot. We live in a ranch which we bought on purpose because I can't do stairs so thankfully the only stairs we have to deal with are the ones going outside. As you can see I'm pretty much planning and changing things based on the first replacement. I'm sure it may not be as bad but I just want to be prepared for any potential situation.

I should hear back from the doctor this week and hopefully he'll go ahead and schedule the surgery and hopefully find out how long my hospital stay will be. I read on the Cleveland CLinic site (not sure if I'm having it there yet) that the stay could be 3-7 days and up to 2 weeks on rehab. I can't imagine if it's going to be longer than that.

I'll keep you updated with what goes on!

 
Old 06-12-2006, 05:41 AM   #9
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Re: Post op pain care

Great Kissa - it sounds like you have everything under control and you've anticipated all the things that could go wrong. Not that anything will go wrong. I'm sure you are a tough cookie and seeing as you are an old pro at this, you should get through it pretty well. My cats tried using my wedge as a scratching post, but found it totally unsatisfactory! So now I use it when I need little pieces of foam here or there as padding for my support "boot" that I have to wear on my right foot sometimes. It also comes in handy if you just want something soft to hit your husband over the head with when getting your aggresions out (only in fun!). We went to a wedding in New York this past weekend. It is the first time in over 2 years that I've been physically able to travel for more than 1 hour without feeling severe pain. We had a terrific time and my Topomax seems to be helping with my pain. I go up to 150 mgs. starting today. And I'm going down on my Methadone starting today to 50-40-50. All the best Kissa - Bye for now - KathyMac

 
Old 06-12-2006, 06:21 AM   #10
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Re: Post op pain care

I'm glad to hear you had a great time, it's so nice when these things happen isn't it? It just makes it all worthwhile in the long run.

Good luck on the Methadone, I pray you hae no problems and all goes smoothly! Keep us updated on that

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Barbie

 
Old 06-12-2006, 08:38 AM   #11
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Re: Post op pain care

Kissa,

I know your pre-op fears. I'm having surgery on my arm in two days and trying not to dwell on the pain management(or lack there of!). My last surgery was 6 months ago and I told anyone and everyone I came in contact with that I take pain meds daily. They assured me they understood and gave me a shot of versed which did nothing. The anesthesiolgist dug around in my shoulder to place the nerve block and it hurt like @#&*! And when I woke up I was in pain and I had to ask for more pain meds over and over becuase they weren't working.

Anyway....sorry to butt in on your thread....just feeling nervous myself.
Good luck with your surgery. You'll be fine with a pca.
Be careful and take care. ~Mush

Last edited by trowftd3; 06-12-2006 at 08:39 AM.

 
Old 06-12-2006, 10:06 AM   #12
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Re: Post op pain care

Good luck with your surgery as well, hopefully it will be smooth sailing. Be sure to tell the anethesiologist that the Versed wasn't effective, usually they use it in combo with Fentanyl.

I will be sure to scream loud enough for the neighborhood to hear me should they not give me appropriate care. Thankfully I have a great husband and will be there advocating for me after the surgery as well.

 
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