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Re: Pain today From: Joanne Bulley (islesannie@yahoo.com) Fri Mar 30 20:18:47 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: book, ultrasound of syndromes" Previous message: art fougner, md: "Re: Criminal Teaching on immediate cord clamping on an infant's pulsating lifeline, the umbilical cord" In reply to: Zach Newton: "Pain today" Zach I agree with you comnpletely. I find that PCA pumps make it more difficult to ambulate (clumsy) and they sure seem (my observations - no RCT...) to be associated with more N&V and related phsiology. My preference is usually Buprenex and Toradol for the first 12-24 hours and then PO NSAID and acetaminophen with hydrocodone etc. I have abdominal hyst patients often going home in 36-48 hours. Yep, I was there with 5-7 day stays and the attendings who would not let the patient have anything other than ice chips until she passed flatus. I also spend a significant bit of office time with her before the surgery explaining what to expect for those post op days. Joanne At Fri, 30 Mar 2001, Zach Newton wrote: > >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 > -- Joanne Bulley, MD, FACOG Keene, NH, USA Next message: art fougner, md: "Re: book, ultrasound of syndromes" Previous message: art fougner, md: "Re: Criminal Teaching on immediate cord clamping on an infant's pulsating lifeline, the umbilical cord" In reply to: Zach Newton: "Pain today"

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