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Pain todayFrom: Zach Newton (zbnewton@mindspring.com)Fri Mar 30 19:00:06 2001
At the start of my career in the early 70's, hospital stay for svd was 3-5 days, hysterectomy 5-7 days. Analgesia was typically 50-100 mg Demerol IM +/- Phenergan 25-50 mg initially, transitionally leading to po aspirin/codeine or aspirin/hydrocodone or equivalent. All available as a prn administered med. In those days, call-response time was typically 30-60 minutes. A lot of hurting between. Today, patient controlled analgesia is a common mode for post-surgical, postpartum (particularly c/s) pain control. Essentially, IV narcotics by demand under controlled dosing. Thinking mainstream, not outliers, alternatives available get the job done better in regard to patient comfort and minimizing needed length of stay. With max pain for our stuff, parental morphine on a scheduled pre-need basis for 12 hours, followed by NSAID universal + prn hydrocodone/ASA or acetominephen works well. The most critical element for the typical patient rests with expectation. This is derived from input of similar prior experience from family/friends (with shading as a function of individual experience and psyche) and *pre-event counselling of what to expect* by physician/CNM. PCA in my view is overkill for the routine that increases costs, regardless of LOS (length of stay), and, because of its use, increases ALOS (average length of stay) with no incremental benefit.
-- Zach Newton Z. B. Newton, III, M.D. Atlanta/Gyn
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