Nurses, I need your help (pain medication)

Where is this set?

Here in the US, it would probably be an on demand pump dispensing morphine or something similar.

Once inserted into the IV line, the patient can self administer the pain suppresant as needed..

Giving the patient control has a double affect, it lets the patient actually administer less meds and saves nurses some time.

I have used them on two separate occassions and found that like the MDs alreay knew, I used less than they had prescribed.

I don't think they were available in the eighties.

Pain meds then would have been given by the nursing staff. Really, really bad pain was treated with percodan which is aspirin with oxycondin. This was a widely misused drug then (as oxycondin is now) and really very tightly controlled. This was normally an oral analgesic. Still in use today is various forms including percocet, vicodin and oxycondin, all are opiates, that is, they are derived from the poppy plant. (as are opium and heroin)

The big ones in injectibles were morphine and demerol which were (are) used to treat medium to severe pain. They bring immediate relief as soon as they enter the blood stream.

Morphine was usually combined with sulfa (morphine sulfate) and dosage is usually every 12 hours. You would not use morphine sulfate if gastrointestinal surgery is indicated because it may mask the symptoms. Demerol (a synthetic) would probably be used.

A metastasized ca might be better if it started as bladder or cervical cancer and then Metasized to the liver. If it starts in the liver and is not stopped, it will kill before spreading. Liver cancer (as the onset location) is comparatively rare in America.

My Dad recently passed after spending several months in the hospital and then 6 weeks home on hospice. He had cancer.

He had many many painful tumors throughout his body including one on his spine. His pain was managed different ways through the different stages of the disease.

At first he took liquid morphine every 4 hours at home. As the disease progressed and he was hospitalized he took morphine every 4 hours and then dilautid every four hours but they were staggered so that every 2 hours he was given something. (i.e. 2:00 morhpine, 4:00 dilautid, 6:00 morphine, 8:00 dilautid...etc.)

The drugs were administered by nurses through his feeding tube. Many cancer patients get a G-tube b/c they can't eat or drink, and if that's the case most medications can be administered through that. Even pills were crushed, mixed with water, and put through the tube.

Eventually he was on a fentanyl patch and also taking liquid morphine about every 30 minutes. That was the last week or so.

Hope this helps.

BudMan said:

I don't think they were available in the eighties.

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That's correct. The official name is patient-controlled analgesia (PCA), and is most commonly fentanyl or morphine. They can be arranged either as a small dose available every 10-15 minutes superimposed on a constant infusion of the same drug or else as just the PCA dose alone. The pump has a maximum dose it will deliver per unit of time as well as a lock-out time, during which the device won't deliver any additional drug. They are very effective at smoothing out the peaks and valleys of drug level in the bloodstream -- it always takes more drug to get control of breakthrough pain than if you prevent that from happening in the first place.

I worked in a nursing home for several years. People in the end stage were on demand for pain meds. This was the last week or so of their life.

My mother died at age 80 about 10 years ago. For the last several years of her life she had bone cancer which progressed to "cancer of the everything" as she put it. All she needed was the occasional Tylonel 3. Perhaps she had a high pain threshold.

She was quite determined that the cancer wouldn't get her saying that she had so little flesh on her that no self respecting cancer could get much of a hold. Perhaps she was right for she died of a stroke; phyrrhic victory so to speak

Don't let the cowboy hat fool you. I've been an RN for years.

PCA pumps first appeared in the 1970s and were in use in some of the major hospitals by the '80s. The first study I read about them was in 1990 or so.

Even today, I've seen many doctors that don't like to use the pumps. When that happens, medications are most often given on an as-needed (PRN) basis and every 4 to 6 hours is common. For a dying patient, the medication can be given more frequently...every hour, as needed. For a patient without a feeding tube and unable to swallow, morphine is usually given sub-lingual (under the tongue).

Hope that helps.

I had abdominal surgery in a military hospital around 1988 and had one of those self-dispense machines full of morphine. They're wonderful. I think I named mine "Bob".