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  • Pain Meds After Surgery, when Opiate Tolerant?

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    Old 05-20-2007, 06:11 PM   #1
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    Exclamation Pain Meds After Surgery, when Opiate Tolerant?

    Need some help!

    Hi Everyone,

    I am having two laparotomies on Thursday. (upper and lower abdomen) This is a last resort for me, and I have never been more scared. It looks like we have worked out a plan for pain management in the hospital (epidural), but what about when I get home?

    It seems like the docs are passing the buck. The pain doc states that the surgeon is in charge of my pain meds until I am released by him, then the pain doc takes over again. Research states that I should stay on my chronic pain meds, and receive additional meds for acute pain.

    My question is, what is appropriate? I know I am having one serious, painful surgery. I currently take Oxycontin 20mgs twice daily, and Percocet 10mgs twice daily. What is an appropriate med to be sent home from the hospital with? Any ideas, or suggestions for handling this situation would be greatly appreciated!



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    Old 05-21-2007, 09:00 AM   #2
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    Re: Pain Meds After Surgery, when Opiate Tolerant?

    Hi Amanda - I can sympathize with you concerning your fears about getting the appropriate pain meds after surgery. I've had 4 laporatomies in my life as well as an emergency colostomy and reversal. At the time I was taking pain meds that were probably comparable to what you are taking at the moment. My experience then, and since then with multiple spinal surgeries, is this: Your existing pain management doctor should take the time to phone the department of anesthesiology where you'll be having your surgery. Not all hospitals know the schedule of which anesthesiologist will be working on which patient during any given week, but your doc should speak to someone who can convey instructions to your particular anesth. Your pain doc should know what kind of meds you're now taking (obviously) and can figure out with your anesth'st. what additional meds will be needed during your initial post-operative period in hospital and beyond. Your pain management doc can then advise the discharging physician as to what meds you should go home on. In my experience the anesthesiology department writes all my prescriptions on discharge for a limited amount of medication. Then they expect you to check with your pain management doc. Amanda, if your pain doc is worth his license he/she should know that you will be having extra pain for at least 4-6 weeks, especially with double laps! If your surgery is THIS Thursday, you better get going on contacting everyone. You know how hard it is to get a doc to do anything outside the normal patient day and this will involve several phone calls. As for the kind and amount of meds you will need in addition to your current pain meds, well that is up to your doc. They may just increase the oxycodone (Percocet) amount. If they don't want to go over the tylenol limit (Percocet has tylenol in it as I'm sure you know), your doc may just put you on plain oxycodone, the opioid found in Percocet, but increase the amount. I hope I've helped in some way. Perhaps this isn't the kind of info you were looking for? Anyway, I'm curious, why are you having this surgery? I'm wishing you lots of luck and all the best! KathyMac

    Old 05-21-2007, 10:23 AM   #3
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    Re: Pain Meds After Surgery, when Opiate Tolerant?

    In my experience they tend to keep you on current meds and add additional short acting narcotics to handle the additional pain of surgery. This is for the inpatient time period. At discharge I've been supplied with adequate take home meds (scripts) and returned to my CP Dr who has always titrated me back down to a resaonable dosage over an appropriate period of time.

    One time I got real concerned and contacted the hospital's pain management advocates before surgery. They were very helpful and ran interference for me so I didn't have to worry so much.

    Best of Luck!


    Old 05-21-2007, 12:09 PM   #4
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    Re: Pain Meds After Surgery, when Opiate Tolerant?

    Hi Amanda...You aren't on that high of a dose of opiate medication. It really should be ok for you after surgery.

    Let me tell you what I did. Before my lung surgery, I went in and talked with the surgeon and told him what meds I was taking at the time and also I would need additional medication after the surgery. I was on the Duragesic patch, 100 mcg, every 48 hours. He understood and told me not to worry, they would make sure I wasn't in pain.

    They had me on the pump after surgery where I could dictate when I needed additional medication, I would just push the button. They would even give me additional medication, if needed, in the IV line. All this and they left the patch on me and even changed it once while I was there.

    When I went hone, I was still on the 100 micro patch, plus they sent me home with 100 Oxycodone tabs for additional pain control.

    So, don't worry about it too much. Just make you docs aware you're on pain meds now (what and doseage) and you'll need additional medication for awhile when you go home and definitely while in the hospital. I hope all goes well for you with the surgery.

    Old 05-21-2007, 04:44 PM   #5
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    Re: Pain Meds After Surgery, when Opiate Tolerant?

    You have gotten some really great advice/information here. I won't speak about the meds for after surgery, because I just don't know anything about how they handle chronic pain patients after a major procedure like you are having.

    I did want to wish you the very best, and let you know I'll send positive thoughts your way for healing and a quick recovery. I hope the doctors will work together to keep you comfortable.

    Take care sweetie!

    Old 05-21-2007, 06:23 PM   #6
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    Re: Pain Meds After Surgery, when Opiate Tolerant?

    I just saw your post. Let me tell you my horror story. I am on Oxycontin 3 xs a day. I take one dose usually in am and doc (pm) allows me to take the other 2 in the evening. He recently had added actiq for breakthrough. First time in 5 years. I had to have neck fusion surgery and down the line my back needs done as well. Anyway, they sent me home from the hospital with vicoden. Did nothing. Called surgeon. Then he decided to discuss with PM doc who was on vacation. Surgery on Friday, home Saturday. This was on the following Wednesday!!! I called surgeon in so much pain. He finally did call pm doc, who had no one standing in for him and was allowed to prescribe percoset. Only one week worth. Went to PM doc today and he now has cut out the actiq for breakthrough as the surgeon says he normally sends pts. home on motrin and I should be in no pain. Well, I am. Surgical pain, still neck pain and the 3 disks in Lower back that still need fused. Surgeon was well aware of what I was on before surgery and said everything would be fine. His PA called me and said I was on too much pain med and I should go to there pain management. I have had my current PM guy for 5 years. Today he was obviously upset that he was called out on his vacation when the surgery had been planned 2 months ahead of time. Plus the surgeon indicated the pm doc could not go on vacation without leaving a number or a contact person. So now I am really gonna be hurting. No more percoset and now no more actiq...I pray this does not happen to you. Just make sure the surgeon and pain doc discuss your management before you have your surgery. I am sure if you do that you will be fine.

    Old 05-21-2007, 08:32 PM   #7
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    Re: Pain Meds After Surgery, when Opiate Tolerant?

    Thank you everyone for all of your posts. I see the pain doc's nurse practitioner on Wed., day before surgery. I pray that I can get something done before then, or that day. I have not even seen my PM doc for over a year! I just see the nurse practitioner. I hope all goes okay and I am not made to suffer due to ignorance. Thanks again everyone. I pray that your well wishes and prayers are well heard!

    Your Friend,


    Old 05-21-2007, 10:34 PM   #8
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    Re: Pain Meds After Surgery, when Opiate Tolerant?

    Hi Amanda. First off, I wish you good luck with the surgery. Please, before going in for the surgery, discuss everything with the surgeon and PM doc and have a plan. It will be alot easier to discuss it first, rather than after, and having the surgeon say you are on to high of a dose, or anything like that. Good luck again..


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