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Old 10-22-2007, 06:00 PM   #1
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Question Pain cocktail injected directly into shoulder surgical site in OR

Hi, everyone ~

I'm scheduled for surgical repair of full thickness tears of the R rotator cuff & biceps tendon. My surgeon said there is a new method of pain control that he now uses that involves injecting the repairs w/ a pain cocktail of 4 meds BEFORE even closing the incision. Has anyone out there had this done? How well did it work? What kind of Rx were you sent home w/? How effective was it?

I'm VERY concerned about post-op pain for several reasons:

1. I've always had a low tolerance for pain & a high tolerance for Rxs.
2. I've been on opiods for the last 10 years for advanced arthritis of the spine & degenerative disc disease. As a result, there's very little left that will even help my back, much less the pain of shoulder surgery.
3. I'll have to D/C my NSAIDs pre-op, so I'll lose that weapon in my pain fighting arsenal.

I could go on, but you've got the idea.

Ill be grateful for any input you have for me!

Thanks so much ~

Kim

 
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Old 10-22-2007, 06:59 PM   #2
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Re: Pain cocktail injected directly into shoulder surgical site in OR

I had torn my bicep tendon in half and shreaded a bunch of things that were just shaved off. I had 2 screws inserted into my bone to re-attach my tendon and I will tell you (not to scare you) but it was the most horrible pain I have ever felt. When I woke up from surgery it took about 10 injections of morphine and then about 5 of dilotted (forgive my spelling) before I could stop screaming from the pain. It was horrible. When I was sent home I left with a script of percocet (5/325) and I think the first 3 days I took somewhere around 30 pills a day because I was in so much pain. After the first 4 days or so, it calmed down a lot and it was manageable. I dont know if something went wrong or if it was because of the screws, but it hurt bad!!! It took about 6 months to get all my range of motion back and for all of the pain to stop completely. But to this day I still cannot sleep like I used to because my arm just will not go into the position I used to sleep. It is too painful. It has been almost 3 years. Good luck and let me know if I can answer anything for you.

 
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Old 10-22-2007, 08:28 PM   #3
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Wink Re: Pain cocktail injected directly into shoulder surgical site in OR

Dear Kim (rlsmas),

I have read the posts already placed on this thread. In fact, I have read and re-read them so many times that I could probably recite them from memory--in spite of the fact I often find difficulty remembering the people in my house! No matter what...I still find what you've stated to sound like there's something "not right" with it. Please take it into account that I know nothing of substance when it comes to pain relief (or help in pain prevention) in this type of context.

Maybe others know something about these kinds of procedures. I highly doubt these types of "pain control" are regularly used at this time!

Truly, it is not my intention to give you a negative feeling, but this doesn't sound quite right!! BY THE WAY...IS THIS REFERRED TO AS A "PAIN BUSTER"? This inquiry is for personal interests since a direct drip into the area where my Mom's knee surgery/replacement/whatever (at Mayo Clinic in Jacksonville, FL) made her believe she didn't even have a paper cut in that area!! This was called a "Pain Buster" by the various physicians and other staff members who understood--including RN's (like you).

Are you able to obtain an independent evaluation by an Anesthesiologist concerning this procedure?? I'm sure a professional opinion would never, ever be this negative. There is a significant difference between "negative" and "truthful"!

Of course, I'm sure others will have more insightful posts. That is one of the good things about this particular Board. Forgive my negativity, but this seems peculiar to my truly ignorant and unprofessional evaluation.

The only item I have suggested that might be helpful is the independent Anesthesiologist's look at the situation.

Please keep us up-to-date concerning this procedure, OK? This type of thing could really affect all of us in various manners.

Sincerely,
Jon (Conductor)

P.S. As an RN, you are keenly aware that Tylox is equivalent to Percocet (oxycodone and acetaminophen). Let's face it, this medication is not all that potent in the grand scheme of things. People like to think it is, but it is used for "moderate to moderately severe pain". There are so many medications that would be more effective--especially for post-op pain! As an RN, Kim, I know you are completely aware of this!

 
Old 10-28-2007, 07:24 AM   #4
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Re: Pain cocktail injected directly into shoulder surgical site in OR

Quote:
Originally Posted by rlsmas View Post
Hi, everyone ~

I'm scheduled for surgical repair of full thickness tears of the R rotator cuff & biceps tendon. My surgeon said there is a new method of pain control that he now uses that involves injecting the repairs w/ a pain cocktail of 4 meds BEFORE even closing the incision. Has anyone out there had this done? How well did it work? What kind of Rx were you sent home w/? How effective was it?

I'm VERY concerned about post-op pain for several reasons:

1. I've always had a low tolerance for pain & a high tolerance for Rxs.
2. I've been on opiods for the last 10 years for advanced arthritis of the spine & degenerative disc disease. As a result, there's very little left that will even help my back, much less the pain of shoulder surgery.
3. I'll have to D/C my NSAIDs pre-op, so I'll lose that weapon in my pain fighting arsenal.

I could go on, but you've got the idea.

Ill be grateful for any input you have for me!

Thanks so much ~

Kim

 
Old 10-28-2007, 07:59 AM   #5
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Smile Re: Pain cocktail injected directly into shoulder surgical site in OR

Hello everyone-
I am 19 days post op from a 75% rotator cuff surgery, along, with shaved off ac bone, and shaved bone spurs and wanted to shed some light for those of you that have questions in terms of pain, meds, etc. etc. This is my personal experience........
I was sent home with a prescription for percocet, kadian (morphine), ketoloric (anti-inflammatory). I do believe I was injected with some kind of numbing medication, because my I didn't begin to feel real pain until about 48 hours after the surgery. I could immediately tell when that started to "wear off". I took two percs every 4 hours, and a morphine pill (1 every 12 hrs), and the anti-inflammatory) every 6 hours. I couldn't tolerate the morphine pill as it made me really "out of it" and nauseous so I only took two in the first few days. The percs weren't strong enough to control my pain so I switched to hydrocodone (vicodan) which helped me deal with the pain a little better. I also had a pain drip gadget connected to my shoulder to administer pain meds for the first few days. It is this little box with wires velcroed to my sling. They removed mine on the 4th post op day at my follow up visit. I was also hooked up to an ice pack with tubes all over the place,which was really heavy and seemed to wear down my already painful shoulder. Sleeping was my biggest challenge as you almost have to be in a "sitting up" position for the first few days.. That was extremely frustrating. The surgery and post op was painful, but not completely intolerable. (I have been through so much worse with a botched disc replacement 4 yrs ago), so this was a "walk in the park" in comparision to what I have been through. Good luck to all.

Last edited by lostpearl63; 10-28-2007 at 08:03 AM. Reason: words missing

 
Old 10-28-2007, 11:21 AM   #6
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Cool Re: Pain cocktail injected directly into shoulder surgical site in OR

Hi, Lostpearl ~

Thanks for your input. I wonder if anyone else out there has had rotator cuff repair & what their experience was like, ESPECIALLY if the site was injected w/ a pain cocktail post-op? There is one doc in the Detroit area who uses a pain pump post-op, but that's about a 2 hour drive for me. Given my back probs & the fact that we're talking about a winter time frame, I'd rather not go there unless it's my only choice.

Any additional war stories, good or bad, would be appreciated!

Kim

 
Old 10-28-2007, 04:05 PM   #7
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Re: Pain cocktail injected directly into shoulder surgical site in OR

Kim,

The person you need to talk to is your anesthiesiologist for your surgery. While your surgeon can do this injection, your pain control after surgery until you are discharged from the hospital is handled by the anesthiesiologist, NOT your surgeon.

I had surgery in May, and due to very bad experiences, I educated myself as much as possible, and met with and discussed my concerns with the surgeon AND anesthiesiologist BEFOREHAND.

Nothing is 100% I had an epidural left in place until 48 hours after surgey and they still had to add oral and extra iv meds to it. Once the epidural was removed, then I had to go to a pain pump with dilaudid. (This was all coordinated by the anesthiesiologists). My surgeon was out one day, and I had his partner. He was the BIGGEST jerk and treated me so badly because I was a chronic pain patient. If it had been up to him, I would have suffered. But it was up to the anesthiesiologist, and he over rode the surgeon and ordered the pain pump with Dilaudid. The surgeon even complained, "I need to discharge this patient!" and the anesthiesiologist said, "Well as soon as her pain is controlled by oral meds, you can, but right now my job is to get her pain under control, and this is what it is going to take." End of story.

I told everyone, all the doctors and the nurses, that I had experienced uncontrolled pain before, and not only did I not want to ever experience it again, I would NOT experience it again. The main anesthiesiologist stated that there are so many things that can be done to achieve pain control, that no one should suffer, and that this was HIS JOB. MY pain control was HIS job!

Needless to say, it was one of the best experiences I have had with a surgery, and I have had 12 total. I was polite, well informed, but assertive. I found out answers to questions like....."what do you do when you are still in pain and the nurse says, you've already had the max...and you should be fine now.....Blah, Blah, Blah.....Ask the nurse kindly to call the anesthiesiologist on-call immediately.

Be proactive, and you will do fine. I think that the post-op injection is a great idea, just don't let your surgeon get tunnel vision. It may work great....meaning it reduces YOUR (everyone is different) pain by 50%. What is his plan for the other 50%, 40%, 30%, ect? If they add Tylox and you are still at 40%, what then? Make sure that he will work with YOU, not numbers from other people before you.

Good luck, and please discuss these issues BEFORE your surgery. Many people take for granted that they are in a hospital, they will not suffer needlessly.....right??? Wrong. It CAN and DOES happen. Don't let it happen to you!

Your Friend,

Amanda

Last edited by butrfligirl28; 10-28-2007 at 04:09 PM.

 
Old 10-28-2007, 07:50 PM   #8
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Talking Re: Pain cocktail injected directly into shoulder surgical site in OR

Dear Amanda ~

Thank you so very much for an AWESOME, informative post!!! Despite the fact that I'm a retired RN, I haven't done hospital nursing in 27 years. When I was still working, surgeons controlled post-op pain Rx, not anesthesiologists. I hope that what you described is the case in this area!

It just happens that my PM doc is an anesthesiologist AND he goes to my church. He's said that he's willing to help manage my pain control once I go home, if necessary.

Thanks again, Amanda, you're an angel!

Kim

 
Old 10-28-2007, 09:23 PM   #9
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Smile Re: Pain cocktail injected directly into shoulder surgical site in OR

I had this surgery in April. The injection you are talking about is basically a nerve block. It certainly does NOT last 72 hours. Mine lasted 8 hours. Then I was rotating morphine, dilaudid and demerol. It was terrible excruciating pain. There's nothing worse than shoulder surgery. I had a complete tear of the rotator cuff, a torn bicep tendon and several bone spurs. I also had "screws" put in. As another poster said, it's awful. I was taking as much Percocet as I could get my hands on. Once you start physical therapy, you need a lot of pain meds. You have to have your pain somewhat manageable in order to do your rehab. The surgeons describe two kinds of pain..."significant" pain is the one they worry about. Theo other pain is the usual pain with rehab. My significant pain didn't go away until 3 months after surgery and I was taking meds the whole time. I am 6 1/2 months post surgery now and I can finally move the shoulder without pain....although at times it still hurts. Unfortunately I have to have the other shoulder done as well. I always thought knee surgery was bad but everyone in the medical community says shoulder surgery is the worst. You have a right to be concerned about post op pain.....so communicate your concerns ahead of time. All though I don't think doctors actually believe us patients until after the fact. Good luck.

I just reread this thread and realized the cocktail injection mentioned is different from the nerve block. It sounds like it is a lot better than the nerve block I had. I'm glad I read this because I still have the other shoulder to do and I'm not anxious to do it of course but I have learned a lot just reading this board and particularly this thread.

Last edited by Omi2008; 10-29-2007 at 08:43 PM. Reason: correction

 
Old 10-31-2007, 09:58 PM   #10
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Re: Pain cocktail injected directly into shoulder surgical site in OR

I think you are having a nerve blockade. I have interscalene injections for pain control and when I researched this I found it commonly used in shoulder surgeries.

They can inject quite a bit of numbing agents in there, it isn't the same as "pain medicines". I agree though at best you might get 8-24 hours help from it. But by then maybe all your meds will kick in together. They can also send you home with a continuous interscalene pump for a few days - if you are med tolerant you should discuss this with the anethesiologist.

 
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