Agony in the recovery room.
February 28, 2011 2:25 PM Subscribe
Yesterday I woke up from an operation in terrible agony. Is this normal (details inside), and if not what should I do?
On Saturday I broke my leg (tib & fib) in three places in a snowboarding accident. I was taken by ambulance to the local hospital which treats many such injuries. I was into surgery the following day and it was obvious the team were completely slammed.
I spent less than 5 minutes with the surgeon (completely inadequate consent -- did not explain a singl and a couple more minutes with the anaesthetist, who convinced my to have a general. I explained to him that I'd had a previous bad experience with general anaesthesia where I was semi-conscious during the whole thing (a long while ago in another country). He reassured my it was his job to make sure nothing like that happened.
I went out like a light. They operated to insert a titanium rod into my tibia. I woke up what seemed like moments later to unendurable agony. I basically had no pain relief. For some reason they only began administering it when I woke up. So I lay there for what seemed like half an hour screaming and begging them to do something, but all they could do was to tell me to take deep breaths.
I'm still in hospital but due to be discharged again. I had another three-minute consultation with the surgeon today but was having a bad reaction to one of the opiates they gave me so although I'd made a list of questions, I'd forgotten to ask about the waking-up-in-pain part.
I've asked the nurses to get the anasthetist to see me so he can explain what happened. The only tidbit of information I have is that they thought I was allergic to morphine (despite having told the anaesthetist and about 20 other people directly that I wasn't allergic to any medication).
They may have thought this because I declined opiates in the ER, but this was simply because I wasn't in that much pain and much prefer NSAIDs.
Update: the surgeon just came to see me having heard I was upset and tried to tell me that it was normal and that they were trying to 'catch up' with the pain relief. I have no idea what that means, if anything.
Final data point: I'm in Canada and this is covered by provincial health insurance. No derails into public/private please.
What is normal here? Is it really normal to wake up screaming after an operation waiting for pain relief to kick in? What are my options here. I am very reluctant to take any legal steps but this was a horrible and harrowing experience.
(Sorry if this seems like a naive question but I've never had an operation before)
On Saturday I broke my leg (tib & fib) in three places in a snowboarding accident. I was taken by ambulance to the local hospital which treats many such injuries. I was into surgery the following day and it was obvious the team were completely slammed.
I spent less than 5 minutes with the surgeon (completely inadequate consent -- did not explain a singl and a couple more minutes with the anaesthetist, who convinced my to have a general. I explained to him that I'd had a previous bad experience with general anaesthesia where I was semi-conscious during the whole thing (a long while ago in another country). He reassured my it was his job to make sure nothing like that happened.
I went out like a light. They operated to insert a titanium rod into my tibia. I woke up what seemed like moments later to unendurable agony. I basically had no pain relief. For some reason they only began administering it when I woke up. So I lay there for what seemed like half an hour screaming and begging them to do something, but all they could do was to tell me to take deep breaths.
I'm still in hospital but due to be discharged again. I had another three-minute consultation with the surgeon today but was having a bad reaction to one of the opiates they gave me so although I'd made a list of questions, I'd forgotten to ask about the waking-up-in-pain part.
I've asked the nurses to get the anasthetist to see me so he can explain what happened. The only tidbit of information I have is that they thought I was allergic to morphine (despite having told the anaesthetist and about 20 other people directly that I wasn't allergic to any medication).
They may have thought this because I declined opiates in the ER, but this was simply because I wasn't in that much pain and much prefer NSAIDs.
Update: the surgeon just came to see me having heard I was upset and tried to tell me that it was normal and that they were trying to 'catch up' with the pain relief. I have no idea what that means, if anything.
Final data point: I'm in Canada and this is covered by provincial health insurance. No derails into public/private please.
What is normal here? Is it really normal to wake up screaming after an operation waiting for pain relief to kick in? What are my options here. I am very reluctant to take any legal steps but this was a horrible and harrowing experience.
(Sorry if this seems like a naive question but I've never had an operation before)
(I'm sorry for my ignorance; I'm not sure if Canadian hospitals have deans or not... Haha!)
posted by two lights above the sea at 2:38 PM on February 28, 2011
posted by two lights above the sea at 2:38 PM on February 28, 2011
I've had general anesthesia three times, and never woken up in agony any of those times. Thirsty? Yes. Disoriented? Yes. Hungry? Yes. In screaming pain? Never.
posted by rtha at 2:40 PM on February 28, 2011
posted by rtha at 2:40 PM on February 28, 2011
IANAL, IANAD. I did work for five years in surgery and have seen a lot.
If you woke up during surgery, that is very much not right at all. It indicates that the anesthesiologist or the anesthetist was not doing their job. That's not to say it doesn't happen, but they should be dosing you with plenty of propofol, nitrous, anesthesia gases, etc. to ensure you don't wake. Also, many use a small brain wave monitor to see how deep of a sleep you are in to prevent the situations where people are awake and paralyzed.
If you woke up after surgery, in pain, in the recovery room, well, I'd be surprised. Most people don't remember much for the first hour or two after surgery, but some do. It does happen where people wake in agony.
If you woke up after surgery, in pain, on the floor, this is common. The nurses and doctors need to manage the pain appropriately. Request a pain doctor, pain management, anesthia, etc until someone actually gets your pain under control.
posted by Mister Fabulous at 2:45 PM on February 28, 2011 [2 favorites]
If you woke up during surgery, that is very much not right at all. It indicates that the anesthesiologist or the anesthetist was not doing their job. That's not to say it doesn't happen, but they should be dosing you with plenty of propofol, nitrous, anesthesia gases, etc. to ensure you don't wake. Also, many use a small brain wave monitor to see how deep of a sleep you are in to prevent the situations where people are awake and paralyzed.
If you woke up after surgery, in pain, in the recovery room, well, I'd be surprised. Most people don't remember much for the first hour or two after surgery, but some do. It does happen where people wake in agony.
If you woke up after surgery, in pain, on the floor, this is common. The nurses and doctors need to manage the pain appropriately. Request a pain doctor, pain management, anesthia, etc until someone actually gets your pain under control.
posted by Mister Fabulous at 2:45 PM on February 28, 2011 [2 favorites]
Mod note: From the OP:
Op hereposted by mathowie (staff) at 2:55 PM on February 28, 2011
Wanted to clarify a few things as still on drugs and didn't make myself clear.
I woke in the recovery room immediately after the operation was completed. I could hear the surgeon dictating her notes but couldn't see much as my eyes were screed shut with pain. They started me on dilaudid (?sp) which gradually kicked in. I was still in severe pain by the time they took me back to the ward.
If you woke up after surgery, in pain, on the floor, this is common....meaning "in your room on the floor", not "on the actual floor". In case anyone else had the momentary mental glitch I did upon reading that phrase.
(sorry, Mister Fabulous)
posted by scrump at 2:59 PM on February 28, 2011 [6 favorites]
If your pain is still not managed, speak to your nurse or surgeon and ask to speak to someone on the pain management team. Let them know you are still having great discomfort, and ask what they can do to help alleviate the pain. They may be able to add another drug or increase the dose of what you're receiving. Dilaudid usually works great for me, morphine not so much. It can be a very individual thing.
It's best if you can get someone in to the hospital who is not medicated to act as your advocate. That is the person who should be bugging your nurses and surgeons until your pain is managed. You can't be expected to do this yourself while under the effects of pain medication.
posted by Felicity Rilke at 3:01 PM on February 28, 2011
It's best if you can get someone in to the hospital who is not medicated to act as your advocate. That is the person who should be bugging your nurses and surgeons until your pain is managed. You can't be expected to do this yourself while under the effects of pain medication.
posted by Felicity Rilke at 3:01 PM on February 28, 2011
As for "catching up with the pain relief", when you have pain and it isn't managed, it can be hard to get to a place where you are comfortable. Sometimes this can mean having to up the dose for awhile until the pain is managed, and then assuring that you get regularly timed doses of medication before you feel pain again. Once you feel pain again, it's harder to get back to that place where you don't have pain.
posted by Felicity Rilke at 3:03 PM on February 28, 2011 [1 favorite]
posted by Felicity Rilke at 3:03 PM on February 28, 2011 [1 favorite]
I had a breast reduction back in September which is actually a pretty major surgery. I remember everything from the moment I woke up after surgery was over. I was still in the operation room and they were calling my name and as soon as I was conscious, I started crying due to the immense pain. The anesthesiologist was there and immediately gave me something until the pain subsided which only took a few minutes. I don't know if it's normal to wake up with so much pain, but I did. The surgeon, the nurses and the anesthesiologist were very attentive to my needs though and managed everything well.
posted by MaryDellamorte at 3:03 PM on February 28, 2011 [1 favorite]
posted by MaryDellamorte at 3:03 PM on February 28, 2011 [1 favorite]
I had the exact same injury that you did -- broken tib and fib playing a sport, then titanium rod. I too woke up in agony in the recovery room, and also i was totally disoriented. I started yelling stuff like "WHY AREN'T YOU HELPING ME!!!" and cursing at the nurses. They did start giving me pain meds basically right away though, and I calmed down pretty quickly and then I started to feel ok. So yeah, just another data point, what happened to you sounds pretty similar to what happened to me.
Memail me or email me (email's in profile) if you want to talk about the recovery process! I'm really sorry to hear about your injury, it's a total bummer.
posted by capnsue at 3:13 PM on February 28, 2011 [1 favorite]
Memail me or email me (email's in profile) if you want to talk about the recovery process! I'm really sorry to hear about your injury, it's a total bummer.
posted by capnsue at 3:13 PM on February 28, 2011 [1 favorite]
Before you do anything else, I would suggest you do this: wait. Wait and get your notes from the surgery. Things will be clearer when you have written records.
My notes from my last surgery indicates I woke up in recovery eighteen times, angry, being abusive, complaining and demanding additional pain relief. I would then conk out, wake up a moment later, wash, rinse and repeat. I actually only remember the last instance of this. I felt so bad I seriously considered sending the recovery nurse flowers.
Recovery is a strange place. TedW may be able to weigh in here but basically, I think they need to know you are concious and awake post-operatively before they can knock you out again for post-surgical pain.
posted by DarlingBri at 3:21 PM on February 28, 2011 [2 favorites]
My notes from my last surgery indicates I woke up in recovery eighteen times, angry, being abusive, complaining and demanding additional pain relief. I would then conk out, wake up a moment later, wash, rinse and repeat. I actually only remember the last instance of this. I felt so bad I seriously considered sending the recovery nurse flowers.
Recovery is a strange place. TedW may be able to weigh in here but basically, I think they need to know you are concious and awake post-operatively before they can knock you out again for post-surgical pain.
posted by DarlingBri at 3:21 PM on February 28, 2011 [2 favorites]
OP, and I mean this with all sympathy because I've been there, I don't think you can take your impressions of what was happening immediately post-surgery as gospel. You were likely whacked out of your gourd and not thinking clearly. I don't mean about the pain; if you were in pain you were in pain. But your sense of the passage of time, your recollection of events, and the timeline of what happened when and where probably can't be trusted. For example you say that it felt like you were laying there screaming in pain for a half hour trying to get someone to do something. But your sense of time post surgery is shot. And your sense of time when in extreme pain is also shot. And so on.
In other words, keep in mind that when you come out of surgery you are not thinking clearly. The advice to get someone to advocate for you is very good advice for just this reason. Another person will not be in a haze of pain, painkillers, etc, and will likely be more effective and getting you help and so on.
posted by Justinian at 3:25 PM on February 28, 2011 [1 favorite]
In other words, keep in mind that when you come out of surgery you are not thinking clearly. The advice to get someone to advocate for you is very good advice for just this reason. Another person will not be in a haze of pain, painkillers, etc, and will likely be more effective and getting you help and so on.
posted by Justinian at 3:25 PM on February 28, 2011 [1 favorite]
I had abdominal surgery and woke up in alot of pain in the recovery room but I wouldn't call it screaming pain. I remember being quite agitated (similar to DarlingBri) because my back hurt from the terrible bed and they didn't have a room ready for me, so I was stuck waiting there for hours. They even brought my family in to calm me down which they don't normally do.
Really, I just second everything DarlingBri said. Maybe they screwed up, maybe it's just that recovery room haze, maybe its your physiology - but wait a little while until your head clears and re-evaluate then.
posted by cabingirl at 3:27 PM on February 28, 2011 [1 favorite]
Really, I just second everything DarlingBri said. Maybe they screwed up, maybe it's just that recovery room haze, maybe its your physiology - but wait a little while until your head clears and re-evaluate then.
posted by cabingirl at 3:27 PM on February 28, 2011 [1 favorite]
Yes, DarlingBri gives a great example of what I mean. People are often not able to follow, understand, or remember what is going on in recovery after a significant surgery. That in no way minimizes your pain or says you can't be correct about the sequence or duration of events, only that you should be very cautious about assuming your recollections are completely accurate or tell the whole story.
posted by Justinian at 3:27 PM on February 28, 2011
posted by Justinian at 3:27 PM on February 28, 2011
I also broke my leg in three places (though after rugby not skiing!) and go a titanium plate and a bunch of screws.
I woke up in severe pain in the recovery room.
That doesn't mean that yours was normal though. Just a data point to say that it has happened to someone else. My doctor, who was a family friend, didn't seem concerned and didn't spend much time with lip service about it. They just gave me some drugs. Which didn't make the pain go away, but it made it less distracting.
On a positive note, this was about three years ago and I have full use of the leg and only very rarely do I still get pain (mostly - get this - when there is a severe drop in pressure - I'm one of those people who can predict the weather with their extremities now).
posted by CharlieSue at 3:28 PM on February 28, 2011
I woke up in severe pain in the recovery room.
That doesn't mean that yours was normal though. Just a data point to say that it has happened to someone else. My doctor, who was a family friend, didn't seem concerned and didn't spend much time with lip service about it. They just gave me some drugs. Which didn't make the pain go away, but it made it less distracting.
On a positive note, this was about three years ago and I have full use of the leg and only very rarely do I still get pain (mostly - get this - when there is a severe drop in pressure - I'm one of those people who can predict the weather with their extremities now).
posted by CharlieSue at 3:28 PM on February 28, 2011
n'thing Justinian. Also, hospitals by ski/snowboard resorts deal with major trauma injuries all the time (and their staff in my experience are extremely good at their jobs).
It's also your first surgery! Of course the trauma is going to seem overblown, confusing, and overwhelming. Having been a hospital patient many times, I can say that I have always been in significant pain with and without painkillers, awake and asleep, and it always seems like you're suffering there longer.
I totally disagree with "legal steps". The hospital documents everything for major injuries; especially if you're waking up during anesthetics / second go-rounds with drugs. I'm sure they've covered themselves. Also, you can have allergies to drugs you've never taken before...how would you know? Maybe there were complications? You can't accurately judge these things until you're clear-headed long after the fact.
And no, you're probably not going to get the anesthesiologist to visit your bedside since s/he is probably busy helping other patients.
posted by Khazk at 3:37 PM on February 28, 2011
It's also your first surgery! Of course the trauma is going to seem overblown, confusing, and overwhelming. Having been a hospital patient many times, I can say that I have always been in significant pain with and without painkillers, awake and asleep, and it always seems like you're suffering there longer.
I totally disagree with "legal steps". The hospital documents everything for major injuries; especially if you're waking up during anesthetics / second go-rounds with drugs. I'm sure they've covered themselves. Also, you can have allergies to drugs you've never taken before...how would you know? Maybe there were complications? You can't accurately judge these things until you're clear-headed long after the fact.
And no, you're probably not going to get the anesthesiologist to visit your bedside since s/he is probably busy helping other patients.
posted by Khazk at 3:37 PM on February 28, 2011
DarlingBri makes an excellent point. I woke up after surgery on my leg screaming and hysterically demanding to know why they had cut! off! my! leg! Apparently there was no reasoning with me, even though my leg was quite obviously (to everyone but me) still there. They gave me something that knocked me out again, and we repeated it several times. Your mind does strange things directly after surgery.
On the other hand, I woke up extremely uncomfortable and remained so for some time, but was not in unendurable pain.
posted by Houstonian at 3:38 PM on February 28, 2011
On the other hand, I woke up extremely uncomfortable and remained so for some time, but was not in unendurable pain.
posted by Houstonian at 3:38 PM on February 28, 2011
Tibial nail with 4 screws - I woke up FURIOUS and in SHRIEKING pain. They had tubed me, so no sound came out when I screamed, but I apparently tried to throw the IV at the doctor who had told me I'd feel better afterwards. This is at an institution with world class care. Once I was conscious though they acted to manage my pain immediately and I was dozing on morphine soon after.
posted by synapse at 3:39 PM on February 28, 2011
posted by synapse at 3:39 PM on February 28, 2011
I woke up in the operating room immediately after thyroid surgery; they were calling my name and asking me to move onto a different bed so they could roll me out. I was seriously pissed and in pain and quite awake. I asked later why I woke up in pain, and they told me they have to make sure you're completely out of the anesthesia before you can be administered pain medication. It didn't take too long to kick in for me. Sorry you're in pain! Complain. They'll give you more meds.
posted by clone boulevard at 3:48 PM on February 28, 2011
posted by clone boulevard at 3:48 PM on February 28, 2011
Do you have red hair? Seriously, people with red hair are said to have a more difficult time with anesthesia. http://well.blogs.nytimes.com/2009/08/06/the-pain-of-being-a-redhead/
posted by MsKim at 3:51 PM on February 28, 2011 [1 favorite]
posted by MsKim at 3:51 PM on February 28, 2011 [1 favorite]
Pain management is not exact. You had a severe injury, and it does take the meds some time to get you to the point where you have enough painkiller in you to work, and for the pain receptors to settle down. You maybe should have gotten more prompt attention. I'm not minimizing how awful the experience was, but I'm not sure it indicates poor care. I hope you heal quickly and with a lot less pain.
posted by theora55 at 3:54 PM on February 28, 2011
posted by theora55 at 3:54 PM on February 28, 2011
I've had a string of surgeries over the last three years. After two of them, I woke up in recovery with a great deal of pain (enough that I was crying/moaning), and it took a while to get it under control. The last surgery was a complicated hysterectomy where they had to make an 18 inch incision down my belly. I remember the eternity it seem to take for the nurse to get my morphine pump up and running. He was chatting up his co-worker and joking around. I was seriously thought he had forgotten about me, and was totally angry (but in control enough to know that being openly hostile towards nursing staff doesn't really help one's situation). But finally, finally he got it going and the pain started to subside. So yeah... as others have said, pain management after surgery is a crap shoot, and not necessarily a sign of negligence.
posted by kimdog at 4:12 PM on February 28, 2011
posted by kimdog at 4:12 PM on February 28, 2011
I've had 4 or 5 general anesthetics and I always wake up in the operating room, typically about one second after they stop giving you the heavy drugs. And I'm totally alert and remember everything no problem.. Scares the crap out of everyone. They also have a hard time knocking me out in the first place so I think this is within the bounds of normal, if a bit unusual.
And most surgeons are pricks, imho, who would much rather never talk to their patients; that's definitely normal.
posted by fshgrl at 4:34 PM on February 28, 2011
And most surgeons are pricks, imho, who would much rather never talk to their patients; that's definitely normal.
posted by fshgrl at 4:34 PM on February 28, 2011
I had surgery on my ankle a few years back and absolutely woke up in pain in the recovery room. Enough pain that yes, all I could communicate to the nurses was "I'm awake now and also OWWWWWWWWWWWWWWWWWWWWW." I was given pain meds and the situation resolved.
So, yes, if you woke up in recovery in pain, that absolutely does happen. In addition, your surgeon also sounds like a bit of a jerk, but the two aren't connected in this case.
posted by sonika at 4:41 PM on February 28, 2011
So, yes, if you woke up in recovery in pain, that absolutely does happen. In addition, your surgeon also sounds like a bit of a jerk, but the two aren't connected in this case.
posted by sonika at 4:41 PM on February 28, 2011
Just a note - do you mean you woke up what you think was immediately after surgery in the recovery room, or simply that it seemed like you were out then awake again?
Either way - that's normal. When you go under, you have no sense of time - you just aren' t there. It generally always feels like you just a split second before were in the OR, even if hours have passed.
If you did wake up in recovery shortly after surgery, that's probably (I'm no expert) good - it's not in your best interests to be under longer than necessary for the surgery - it has it's risks. IF you woke up during surgery - that's another story.
Poor pain management? I feel for you, that's wrong - hopefully that was fixed.
Dilaudid is an opioid, very strong and strictly controlled - if they had you on that and you were still in pain, morphine probably wouldn't have done you better - a dosage adjustment is probably what was needed. They definitely were administering some strong drugs - which may be an indication of the amount of pain you were in (which is natural)
There is also, I believe, a reluctance to over-use sedating medication during recovery (from anesthesia) because it takes a varying amount of time for it to wear off on different people - loading them to the gills on morphine or the like before you wake up is probably not a good practice.
As others said, this was a painful injury and a traumatic surgery - pain is expected, and pain management is not perfect science. They probably could have done a better job - but what others say about your sense of time and recollection of events is also true - I recall surgery where I woke up in recovery, was wheeled back to my room, called home to mom & dad to tell them I was allrgiht, had a few visitors, had a nap, woke up, and didn't remember any of it, despite being apparently lucid at the time. For the same reason, they are reluctant to let you stand up and take a leak, even though you seem fine, because you could just pass out without warning and bash your head on the toilet or sink - on way to tell.
(the visits and the phone call sort of came back to me days later... but I didn't recall a thing for a while)
Sorry you were in such agony, hope you feel better.
posted by TravellingDen at 5:20 PM on February 28, 2011
Either way - that's normal. When you go under, you have no sense of time - you just aren' t there. It generally always feels like you just a split second before were in the OR, even if hours have passed.
If you did wake up in recovery shortly after surgery, that's probably (I'm no expert) good - it's not in your best interests to be under longer than necessary for the surgery - it has it's risks. IF you woke up during surgery - that's another story.
Poor pain management? I feel for you, that's wrong - hopefully that was fixed.
Dilaudid is an opioid, very strong and strictly controlled - if they had you on that and you were still in pain, morphine probably wouldn't have done you better - a dosage adjustment is probably what was needed. They definitely were administering some strong drugs - which may be an indication of the amount of pain you were in (which is natural)
There is also, I believe, a reluctance to over-use sedating medication during recovery (from anesthesia) because it takes a varying amount of time for it to wear off on different people - loading them to the gills on morphine or the like before you wake up is probably not a good practice.
As others said, this was a painful injury and a traumatic surgery - pain is expected, and pain management is not perfect science. They probably could have done a better job - but what others say about your sense of time and recollection of events is also true - I recall surgery where I woke up in recovery, was wheeled back to my room, called home to mom & dad to tell them I was allrgiht, had a few visitors, had a nap, woke up, and didn't remember any of it, despite being apparently lucid at the time. For the same reason, they are reluctant to let you stand up and take a leak, even though you seem fine, because you could just pass out without warning and bash your head on the toilet or sink - on way to tell.
(the visits and the phone call sort of came back to me days later... but I didn't recall a thing for a while)
Sorry you were in such agony, hope you feel better.
posted by TravellingDen at 5:20 PM on February 28, 2011
IANAD(Y), but I am spending two weeks on an anesthesia rotation currently. In the best scenario, the anesthesiologist will be giving you intravenous pain medication throughout the operation to control your pain even while you're unconscious. Ideally, this should carry over into the post-operative period. This may not have happened, for one reason or another, or possibly your body is just wired such that it takes a lot more medication than most people need to get the same level of pain control. The fact that you're having a bad reaction to an opiate may have something to do with it -- maybe they tried something and had to stop it due to a reaction. Sometimes the kind of procedure that's being done precludes the use of certain medications, e.g. some orthopedic surgeons prefer that their patients don't get anti-inflammatory medication during the procedure since it could affect bone healing. Either way, hearing a third-hand tale about a supposed morphine allergy isn't going to give you the full picture. Miscommunication is often the name of the game in hospitals.
I wouldn't say it's unusual to wake up in the recovery room having pain, and it should definitely be looked after quickly, but as others are pointing out, it's sometimes hard to balance keeping the patient awake and breathing sufficiently at the same time as trying to control their pain.
As for asking to speak to the anesthesiologist, as others are saying, it's probably not likely to happen, but I think that if you've had a bad experience, you should certainly write a letter to the hospital higher-ups and/or chief of anesthesia and/or chief of orthopedics. Surgeons (not to mention other kinds of physicians) can be pretty cavalier about patient care sometimes; it's inexcusable, but it happens. Until we start restricting medical school admission to people who can be scientifically shown to be empathetic, it's likely to remain that way, unfortunately.
Many hospitals have something called an Acute Pain Service, which is an on-call anesthesiologist who looks after the pain management of post-op patients. If you're going to be in hospital much longer, you might want to ask your nurse to give them a call (if indeed your hospital has one).
Sorry that you had a bad experience -- but hopefully you'll be feeling better soon! Try to rest, and remember that you'll be able to look back on the experience one day and it'll be in the distant past. The last time I had surgery, I felt miserable for quite a while, both acutely and for weeks afterwards, but it's firmly in past, and I won't be signing up for surgery anytime again soon!
posted by greatgefilte at 5:32 PM on February 28, 2011 [2 favorites]
I wouldn't say it's unusual to wake up in the recovery room having pain, and it should definitely be looked after quickly, but as others are pointing out, it's sometimes hard to balance keeping the patient awake and breathing sufficiently at the same time as trying to control their pain.
As for asking to speak to the anesthesiologist, as others are saying, it's probably not likely to happen, but I think that if you've had a bad experience, you should certainly write a letter to the hospital higher-ups and/or chief of anesthesia and/or chief of orthopedics. Surgeons (not to mention other kinds of physicians) can be pretty cavalier about patient care sometimes; it's inexcusable, but it happens. Until we start restricting medical school admission to people who can be scientifically shown to be empathetic, it's likely to remain that way, unfortunately.
Many hospitals have something called an Acute Pain Service, which is an on-call anesthesiologist who looks after the pain management of post-op patients. If you're going to be in hospital much longer, you might want to ask your nurse to give them a call (if indeed your hospital has one).
Sorry that you had a bad experience -- but hopefully you'll be feeling better soon! Try to rest, and remember that you'll be able to look back on the experience one day and it'll be in the distant past. The last time I had surgery, I felt miserable for quite a while, both acutely and for weeks afterwards, but it's firmly in past, and I won't be signing up for surgery anytime again soon!
posted by greatgefilte at 5:32 PM on February 28, 2011 [2 favorites]
I had a c-section under general anesthesia and woke up in recovery in a great deal of pain. The only thing I really remember clearly was asking where the baby was and moaning "it hurts, it hurts" over and over again. I was also told they had to "catch up" to my pain and that this was a lot harder to do with general anesthesia versus the spinal anesthesia used during most c-sections because when you're knocked out, there's no real way to articulate what you're feeling, obviously, so sometimes you come out of it hurting a whole lot. They hooked me up to a morphine pump where I could push the button when I needed more, and I pushed that button like it was my job for the first hour or so.
Also, I apparently had a conversation with my husband that I absolutely do not remember while I was in recovery, so things definitely get a little wacky when you've just woken up from surgery.
posted by chiababe at 7:03 PM on February 28, 2011
Also, I apparently had a conversation with my husband that I absolutely do not remember while I was in recovery, so things definitely get a little wacky when you've just woken up from surgery.
posted by chiababe at 7:03 PM on February 28, 2011
Just another patient data point here, but I have had 4 operations under general anesthesia and every time I awoke in the recovery room I was in a great deal of pain, but I did not care because I was on a great deal of medication. Usually a morphine drip if I recall. My recollections were that I would wake up, tell whomever was with me that this sucks and hurts, drool on myself a little bit and pass back out. I am told that I had a few paragraph length discussions about very random things that I have no recollection of.
When I woke in my room later that day, I was in some pain, but was still medicated. For the most part, they did not want me "too medicated" because they wanted me to get up and out of bed, they wanted me to urinate on my own so no cath would be needed and they wanted me to be able to discuss the operation in terms of my reaction and pain. Once I had done all that, they were willing to give me whatever I wanted.
As for the anesthesiologist, I asked to meet him the night before the first operation. When he arrived, I couldn't really think of anything to ask him other than what his percentage was. He asked percentage of what and I said percentage you lose. He smiled and said jokingly, "only lost a few". I asked him where he went to med school and where he did his residency but I have no idea what I was going to do with that information. I did come to the conclusion that since half the doctors graduate in the bottom half of the class, I had a 50-50 shot of having a guy who was worse that half his graduating cohort. The next three operations I asked the surgeon if he was ok with the anesthesiologist assigned to my case. He was. I spoke to him to sign the consent and ask about his bill rate.
posted by JohnnyGunn at 7:53 PM on February 28, 2011
When I woke in my room later that day, I was in some pain, but was still medicated. For the most part, they did not want me "too medicated" because they wanted me to get up and out of bed, they wanted me to urinate on my own so no cath would be needed and they wanted me to be able to discuss the operation in terms of my reaction and pain. Once I had done all that, they were willing to give me whatever I wanted.
As for the anesthesiologist, I asked to meet him the night before the first operation. When he arrived, I couldn't really think of anything to ask him other than what his percentage was. He asked percentage of what and I said percentage you lose. He smiled and said jokingly, "only lost a few". I asked him where he went to med school and where he did his residency but I have no idea what I was going to do with that information. I did come to the conclusion that since half the doctors graduate in the bottom half of the class, I had a 50-50 shot of having a guy who was worse that half his graduating cohort. The next three operations I asked the surgeon if he was ok with the anesthesiologist assigned to my case. He was. I spoke to him to sign the consent and ask about his bill rate.
posted by JohnnyGunn at 7:53 PM on February 28, 2011
"... What is normal here? Is it really normal to wake up screaming after an operation waiting for pain relief to kick in? What are my options here. ..."
I "woke up" in the middle of a hip joint replacement operation, and although I couldn't move, I heard my orthopedic surgeon (a physically small man) cursing my anatomy, as he tried to break my leg. Took him maybe 15 minutes to break it, too, and he called in his PA, and the representative of the provider of his hip joint replacement prosthesis (and the tools he needed from them, to conically drill the remainder of my femur, and to cut my hip saddle for the receiving "cup" of the prosthesis). Eventually, my moaning and some tensing of voluntary muscles I made, caused the surgeon to complain to the anesthesiologist about the state of my anesthesia, and I think I got a helluva hypnotic dose, and perhaps some analagesic.
The next thing I remember, I was in the recovery room, with my surgeon poking a stiff finger repeatedly in my chest. "Hey.", "Hey, boy." "Hey!" "Wake up, dammit!" I made some noise, and the poking stopped, and someone said "Yeah, he'll come around." My left arm hurt like hell, and I begged for someone to look at it, but no one did, in the recovery room.
Sometime later, (2 days as it turned out), I'm aware of fire down both my legs, from my butt to my knees, and my left arm is aching/throbbing, from my fingers to my lung. My parents are at the foot of a bed I'm lying in, and all I hope is that I will die, pretty soon now. I've never hurt this bad, and that includes multiple bones broken in various motorcycle accidents. Really, I'd have checked out, right then, if I'd had a button.
"They stopped all the pain killers." I hear my Dad say, as I come around. "You weren't breathing well, and they had no choice."
"Augggghhhh." I hear myself reply. And for the next 2 days, all I did was cry, scream and beg for relief. They took me to one end of a ward, and no one imagined putting a roommate in with me. But you don't get opiates in any form if you don't breathe satisfactorily, and I was in, and out, and in, and mercifully, out.
When I came back "in" for good, I was looking at my surgeon, and some junior representative of the hospital's group anesthesiologist's practice. "You nearly went out on us." said the surgeon. "We'll have to be careful about your pain medication in the next few days." The junior man nodded, and looked wise.
I got up and walked on two new hip joints on 2 tabs, every 8 hours, of Tylenol 3, for the next 10 days. It was nearly 3 months before I got back full range of motion in my left arm, as a result of post-operative trauma. And I remember, in detail, nearly every damned step, and every hateful day of that recuperation, and if anyone had told me what I was facing, beforehand, with any accuracy, I'd have thrown myself in front of a bus, before reporting for voluntary butchering.
Nothing, including the intervening 15 years, and another hip joint replacement, were worth that suffering.
Sorry to hear that you're hurtin', pal. Modern medicine, apparently, is still not all it's cracked up to be, by its most ardent fans.
posted by paulsc at 9:11 PM on February 28, 2011 [2 favorites]
I "woke up" in the middle of a hip joint replacement operation, and although I couldn't move, I heard my orthopedic surgeon (a physically small man) cursing my anatomy, as he tried to break my leg. Took him maybe 15 minutes to break it, too, and he called in his PA, and the representative of the provider of his hip joint replacement prosthesis (and the tools he needed from them, to conically drill the remainder of my femur, and to cut my hip saddle for the receiving "cup" of the prosthesis). Eventually, my moaning and some tensing of voluntary muscles I made, caused the surgeon to complain to the anesthesiologist about the state of my anesthesia, and I think I got a helluva hypnotic dose, and perhaps some analagesic.
The next thing I remember, I was in the recovery room, with my surgeon poking a stiff finger repeatedly in my chest. "Hey.", "Hey, boy." "Hey!" "Wake up, dammit!" I made some noise, and the poking stopped, and someone said "Yeah, he'll come around." My left arm hurt like hell, and I begged for someone to look at it, but no one did, in the recovery room.
Sometime later, (2 days as it turned out), I'm aware of fire down both my legs, from my butt to my knees, and my left arm is aching/throbbing, from my fingers to my lung. My parents are at the foot of a bed I'm lying in, and all I hope is that I will die, pretty soon now. I've never hurt this bad, and that includes multiple bones broken in various motorcycle accidents. Really, I'd have checked out, right then, if I'd had a button.
"They stopped all the pain killers." I hear my Dad say, as I come around. "You weren't breathing well, and they had no choice."
"Augggghhhh." I hear myself reply. And for the next 2 days, all I did was cry, scream and beg for relief. They took me to one end of a ward, and no one imagined putting a roommate in with me. But you don't get opiates in any form if you don't breathe satisfactorily, and I was in, and out, and in, and mercifully, out.
When I came back "in" for good, I was looking at my surgeon, and some junior representative of the hospital's group anesthesiologist's practice. "You nearly went out on us." said the surgeon. "We'll have to be careful about your pain medication in the next few days." The junior man nodded, and looked wise.
I got up and walked on two new hip joints on 2 tabs, every 8 hours, of Tylenol 3, for the next 10 days. It was nearly 3 months before I got back full range of motion in my left arm, as a result of post-operative trauma. And I remember, in detail, nearly every damned step, and every hateful day of that recuperation, and if anyone had told me what I was facing, beforehand, with any accuracy, I'd have thrown myself in front of a bus, before reporting for voluntary butchering.
Nothing, including the intervening 15 years, and another hip joint replacement, were worth that suffering.
Sorry to hear that you're hurtin', pal. Modern medicine, apparently, is still not all it's cracked up to be, by its most ardent fans.
posted by paulsc at 9:11 PM on February 28, 2011 [2 favorites]
Perhaps you had some kind of incident on the table that made them want to use minimal amounts of pain killers? When my friend was in our car accident with me, she had a broken femur (in 2 places). Because she lost consciousness at the scene, the paramedics were unable to give her more than the most minute dose of narcotic pain relief. In fact, she didn't get any in the ER until they were ready to discharge her.
That said, after her surgery to fix her knee, they did give her a local shot of some kind, before closing her up, that kept her leg numb for several hours afterwards so she wasn't in as much pain. I don't know why they didn't give that to you.
posted by IndigoRain at 11:10 PM on February 28, 2011
That said, after her surgery to fix her knee, they did give her a local shot of some kind, before closing her up, that kept her leg numb for several hours afterwards so she wasn't in as much pain. I don't know why they didn't give that to you.
posted by IndigoRain at 11:10 PM on February 28, 2011
A lot of good data points here demonstrating that pain relief varies a good bit from patient to patient and it can be hard to gauge what to give any individual patient after surgery until they are awake and coherent enough to tell you how they feel (it gets even harder with little kids who are too young to talk).
Without knowing exactly what was done and what drugs were given to you it is hard to say whether your treatment was appropriate or not. I have done anesthesia for many of these types of surgeries and I can tell you how I approach them. Typically a general anesthetic as you had; If the patient is in pain preop I might give some pain medicine at that time, and definitely give some while they are asleep. My first line choices are morphine or its synthetic cousin fentanyl. With an injury like yours I would avoid NSAIDs unless I had discussed it with the surgeon. There are 3 reasons for this: They are not likely to be adequate for this sort of pain, they inhibit platelet function and may increase the risk of bleeding, and some orthopedic surgeons feel there is evidence that they may impair bone healing. Despite my best attempts to treat pain before the patient wakes up, some are still in pain; unfortunately large doses of narcotics depress breathing and consciousness and so you have to balance those risks against the risk of inadequate pain control. For that reason almost all of our patients have orders for additional pain medication in recovery (typically the aforementioned morphine or fentanyl) and if that still doesn't do the trick our nurses do not hesitate to call for additional orders. Hydromorphone (the Dilaudid you mentioned) is often my go-to drug for difficult to treat pain, so it is a reasonable choice for you to have gotten. We try to get everyones pain under reaasonable control before they leave the recovery room (although "reasonable varies from patient to patient).
Once the patient leaves the recovery room pain management becomes the responsiblilty of the surgeon unless there is an epidural catheter or other technique that is run by the acute pain service. Even so someone from the anesthesia department checks on inpatients the next day and can certainly relay any concerns about pain management to the surgeon. While being completely pain-free may not be realistic, your pain should be controlled to the point where you can rest in bed and eat, sleep, or watch TV (if you have to do physical therapy, though, I am told it will probably hurt no matter what you do). So feel free to let you physicians and nurses know what is going on. In particular you should talk to your surgeon; intolerable pain may indicate a problem with the surgery that needs to be looked at, or it may be something such as muscle spasms (sometimes a problem after orthopedic surgery) that are better treated with a muscle relaxant than pain meds.
In any event, you should be taken seriously when you are in pain. I do not know how things work in Canada, but in the US the major accrediting body for hospitals, The Joint Commission, has made adequate pain management a priority for the last 10 years.
Sorry to hear you are having a rough time and hope you feel better soon. From what I have seen most people start feeling a lot better about 48 hours after their surgery, so you are near the end of the worst part. Feel free to memail me if there is any addditional information I can give you.
posted by TedW at 6:21 AM on March 1, 2011 [6 favorites]
Without knowing exactly what was done and what drugs were given to you it is hard to say whether your treatment was appropriate or not. I have done anesthesia for many of these types of surgeries and I can tell you how I approach them. Typically a general anesthetic as you had; If the patient is in pain preop I might give some pain medicine at that time, and definitely give some while they are asleep. My first line choices are morphine or its synthetic cousin fentanyl. With an injury like yours I would avoid NSAIDs unless I had discussed it with the surgeon. There are 3 reasons for this: They are not likely to be adequate for this sort of pain, they inhibit platelet function and may increase the risk of bleeding, and some orthopedic surgeons feel there is evidence that they may impair bone healing. Despite my best attempts to treat pain before the patient wakes up, some are still in pain; unfortunately large doses of narcotics depress breathing and consciousness and so you have to balance those risks against the risk of inadequate pain control. For that reason almost all of our patients have orders for additional pain medication in recovery (typically the aforementioned morphine or fentanyl) and if that still doesn't do the trick our nurses do not hesitate to call for additional orders. Hydromorphone (the Dilaudid you mentioned) is often my go-to drug for difficult to treat pain, so it is a reasonable choice for you to have gotten. We try to get everyones pain under reaasonable control before they leave the recovery room (although "reasonable varies from patient to patient).
Once the patient leaves the recovery room pain management becomes the responsiblilty of the surgeon unless there is an epidural catheter or other technique that is run by the acute pain service. Even so someone from the anesthesia department checks on inpatients the next day and can certainly relay any concerns about pain management to the surgeon. While being completely pain-free may not be realistic, your pain should be controlled to the point where you can rest in bed and eat, sleep, or watch TV (if you have to do physical therapy, though, I am told it will probably hurt no matter what you do). So feel free to let you physicians and nurses know what is going on. In particular you should talk to your surgeon; intolerable pain may indicate a problem with the surgery that needs to be looked at, or it may be something such as muscle spasms (sometimes a problem after orthopedic surgery) that are better treated with a muscle relaxant than pain meds.
In any event, you should be taken seriously when you are in pain. I do not know how things work in Canada, but in the US the major accrediting body for hospitals, The Joint Commission, has made adequate pain management a priority for the last 10 years.
Sorry to hear you are having a rough time and hope you feel better soon. From what I have seen most people start feeling a lot better about 48 hours after their surgery, so you are near the end of the worst part. Feel free to memail me if there is any addditional information I can give you.
posted by TedW at 6:21 AM on March 1, 2011 [6 favorites]
Mod note: From the OP:
OP here once more. Thank you everyone for your responses.posted by jessamyn (staff) at 5:58 AM on March 2, 2011
I'm finally home and reasonably comfortable. Off opiates and managing
on Tylenol, able to get to bathroom on crutches etc.
As you guys predicted I was not able to speak to the anaesthetist but
I had two fairly uncomfortable sessions with the surgeon where I tried
to explain what I found problematic (the less-than-perfunctory
consent, and the lack of analgesia in the recovery room).
She didn't really have a response to the first (for example, when I
pointed out she hadn't told me any of the risks involved, or the
success rate of the surgery, or any possible complications, or any
treatment options, or anything about prognosis) except to assert that
she'd followed their normal routine. She seemed very pissed with me
for questioning her actions but we'll live. I got the impression she
was not well-liked by the nursing staff and she seemed very sloppy
(forgetting on two occasions to actually write up scripts for stuff
she'd told the staff to give me).
On the question of the analgesia, it is obvious from the responses
here and elsewhere that what I suffered is not at all uncommon and may
be well within the normal range of experiences for this kind of
surgery.
I spoked to another surgeon (friend of a friend) who told me it is
fairly common with a general not to being serious analgesia until the
patient is extubated and alert.
This may have become more of an issue recently as Pethidine/Demerol
has fallen out of favour as an analgesic. This was the drug that was
largely responsible for people forgetting what happened in the
recovery room, but is now not widely used for various reasons, so
people like me are more likely to remember acute pain in the RR
afterwards.
So to me this also comes down to a question of consent. Either what
happened to me was within expectations -- in which case I surely
should have been told that there was a chance I would wake up in
extreme discomfort from the general -- or it wasn't, in which case
there should be another explanation.
This would obviously have conditioned my decision to have a general or
a spinal (which the anaesthetist offered but the surgeon says I was
never a candidate for).
The bigger take-away is what other people have said: when you are in
pain, on drugs, scared, and wearing a hospital gown which exposes your
genitals, you are in no position to self-advocate.
At this point I have no reason to think that either the surgeon or the
anaesthetist did anything but their best work in the OR but I do think
that their pre-op procedure was badly flawed, especially with respect
to consent, and I will probably take this up with the hospital
ombudsman once I am out of the woods, hopefully to make them slow down
and clean up their act a little bit.
If anyone has links to standards for consent for surgical
procedures/anesthesia I would be grateful.
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posted by two lights above the sea at 2:33 PM on February 28, 2011