Can you help me out with a drugs schedule?

[ShowOfHands]

I've just come out of hospital after - the surgeon's words - a "brutal" hysterectomy. I've had ongoing issues for a long time and what was scheduled to be laparoscopic following months of drugs to shrink fibroids and my bulky uterus, turned into a hip to hip incision because the drugs obviously hasn't worked and everything was much bigger with lots of adhesions from previous caesareans and some other problems with organs all wrapped round each other and hard to separate. I've got quite a lot of incisions, including the big one and a very black and blue abdomen.

In hospital, I was on a morphine pump, IV paracetamol and they brought round ibuprofen regularly as well. This worked well. Because they were on a skeleton staff at the point of discharge, they started taking me off everything and then there were loads of delays and hours later, I eventually headed home but pain had started to set in. I got home in quite a lot of discomfort last night, having had nothing for about 6hrs at this point and by 3am, I was in agony. I need to stop that happening again as I couldn't walk or take a deep breath.

I've got the following drugs to take for 3 days:

Dihydrocodeine - one every 4-6 hours (no more than 6 in 24hrs).
Ibuprofen - 2 tablets 3 times a day.
Paracetamol - 2 tablets 4 times a day.

I'm then going to drop the dihydrocodeine and alternate ibuprofen and paracetamol for 2 weeks.

The above is all on the advice of the hospital but I want to make it as effective as possible so that I'm not ending up in the pain I did last night. I'm still woozy from the general anaesthetic on Friday night and have lost all track of time and sense. I've been told to try the above and ring and ask for oramorph if it's not enough. I'm sure it is enough but how should I be taking this? Are they best spaced out or do two of them work better taken together?

I've got laxatives as well so not worried about that and have a schedule for blood thinners and other meds I've got. I just need to sort out pain relief in a sensible way.

I took Ibuprofen and Paracetamol at 10pm last night and dihydrocodeine at 1am.

I'd go for dihydrocodeine every four hours and alternate it with either ibuprofen or paracetamol. That leaves you one spare dose of paracetamol just in case. I'd set an alarm and take day and night. Hope you feel better soon.

Don't take the ibuprofen and paracetamol together. They are each safe to take every 4 hours, so you take paracetamol at, for example, 8, 12, 4, 8 but take the ibuprofen at 6, 10, 2, 6.
I would suggest taking the dhc at bed time.
Take an osmotic stool softener at night and a gentle stimulant laxative too.
Get some glycerine suppositories just in case.
Drink plenty, mobilise as much as possible.

Sorry x post.
Dhc knocks me out which is why I suggested bed time.
However, the key thing is to alternate, to keep levels steady so you don't get pain coming back when painkillers wear off.

Two different replies, one suggesting dihydrocodeine regularly and one suggesting only at night. I really don't know what to take and when.

And I don't know what an osmotic stool softener is. I'll Google it. I've been given lactulose by the hospital.

That makes sense as codeine knocks me out too.

Is there a chance with this schedule that I'll end up in pain overnight or do I just cover overnight with the dihydrocodeine and take the others during the day only?

Lactulose is perfect.
Dhc is a controlled very strong drug so check what it says on your discharge summary and on the box about how often to take it.

Sorry to hear this Showy. I have no expertise/experience to offer but just wanted to pass my sympathy to a much loved MNer who has given much comfort and help to young mothers over the years. It sounds bloody awful, but this too shall pass.

I would take the dhc at night. How often does it say on the box?

I've typed the dosage instructions as they appear on the box in my op: "Dihydrocodeine - one every 4-6 hours (no more than 6 in 24hrs)"

I really don't want to end up with constipation either but I will swig the lactulose as directed and I'm drinking lots and eating a good diet.

Aww shucks.

Thank-you. I just want to return to normal now. It's been a rough ride.

Sorry I just woke up and missed some of your op. Classic mn mistake.
You could take dhc instead of a 4th ibuprofen and cover night time with dhc.

There will be a bit of trial and error in this for you, different things will work slightly better for some people than others.
Definitely do not become constipated if you can possibly avoid.
if it were me I would take a couple of paracetamol and a dhc first thing & last thing and see how I go from there, but that’s because I’m fine with codeine it doesn’t make me nauseated or spinny, ymmv.

don’t wait until pain is unbearable to take painkillers, it will all work better if you keep the pain at a manageable level, so if you’ve taken morning dose & it’s heading towards lunchtime & pain is starting to increase, take your next dose at the appropriate time, don’t wait til
mid - afternoon and being so sore you can’t breathe.
it won’t be forever.
do not lift anything (including the hoover) for at least a week, more like a fortnight. Do keep very gently moving.

Whe I last came out of hospital dh made a meds chart and I ticked them off as I took them. There was a bit of trial and error but I recorded a pain score at intervals round the clock and that really helped to figure out the best schedule.
I hope you get to grips with a combination that works for you.

Oh, @ShowOfHands going through this painful recovery is tough, but you will get there. I'm currently on various meds to control horrendous back pain, including codeine. Like you I don't want to overdo it so I have two last thing at night (11-12) then two around midday. That's reduced from 4 doses which I started on, and as soon as I can stand it I'm going to drop the lunchtime dose.
I'd call your GP tomorrow and discuss it as they may give you more to get you through these first few days. Get well soon!

Becoming sore is what I'm trying to avoid. I want a schedule to stick to and if it doesn't work, I can tweak it. This was the advice from the hospital and the physio but they didn't tell me which drugs to take in which order.

I have a high pain threshold usually and I almost never take a thing, not even paracetamol. This is all so new and I haven't really slept since Friday morning so can't quite make a decision on my own.

I've just taken ibuprofen and will take paracetamol in a couple of hours. I'll stick with alternating and then change to codeine this evening. I'll write everything down.

You may not need the dhc after a few days or a week. Good early pain management will help.l your recovery. There are no medals for not taking painkillers, no one will know or care.as long as you aren’t underweight, and you keep within the recommended daily dosing you’re not likely to do yourself a damage. I would add to above, as well as morning and evening I would take something at lunch time, see how you’re feeling, a couple of paracetamol might be enough, early days, you might need another dhc.
sorry SoH I also did not realise it was you ( you don’t “know” me, but I’ve been about a long time)

Paracetamol is your base drug and everything else works off that. You can take Ibuprofen at the same time or schedule it in between. The latter would cut down the time in between doses. Dihydrocideine is for breakthrough pain and not necessarily a regular medication

I've been told codeine for 3 days only and don't worry, I will not be a martyr about this. This surgery comes after 14 months of daily bleeding, occasional haemorrhaging and horrific discomfort. Life has been a shadow of what it should have been for so long that I'm determined to recover well and quickly. I want my life back. I will take all meds, walk regularly, do my physio and generally plod towards some semblance of normal.

Also if it were me, bedtime dhc would be the last one to go, as you will heal better off a sleep that isn’t interrupted by pain.
I agree with pp that paracetamol is good baseline and again I might aim for that 4 x a day for a few days.
personally ibuprofen gives me a tummy ache, make sure you have some food before it (again ymmv).
pain relief isn’t one size fits all. Glad you’ve seen physio.
take things as easy as you possibly can (I cannot emphasise this enough - do not over do it!) for a few weeks .
hope you feel better soon. You can feel a bit weird after a general for a good couple of weeks.

I've just had to Google "YMMV"...

Sorry
how’s it going?

Only taking dhc at bedtime is great advice if you have responsibilities and need your wits during the day. If you have not much to do except focus on recovery, I'd be taking it through the day as well. It won't harm you, but it may make you feel a bit sleepy or slow.

When the dhc runs out, you can take otc cocodamol instead of your paracetamol if you need something a little stronger. Has to be instead of the paracetamol though. Don't take both or you'll end up back in the hospital.

Hope your recovery is going well.