To be shocked at how much post-op pain I'm in?

[plasticbanana98]

A week ago, two weeks into a lovely honeymoon that should have lasted 3.5 weeks, I fell and broke my wrist very badly (displaced distal radius Smith fracture). It was in Japan, they x rayed and assessed me, gave me a temporary splint and was told I had to go home asap for surgery. Sorted insurance stuff and they flew us back mid week, have managed pain with OTC meds plus codeine. A & E Thursday and they got me in for my surgery Saturday as an urgent case. I've had a plate and screws inserted and my fracture realigned with a cast, signed off work for a month.

The nurses were kind, but my pain management for the 36 hours I was in hospital was totally inadequate. They gave one ibuprofen with two paracetamol every 6-8 hrs, I know that's first line pain relief and then low dose oromorph every 4 hrs. I've had oromorph before after knee surgery and it was good, but it wasn't helping this time- not sure if dose too low? It wasn't enough, my pain was still so bad so they reluctantly got me a tramadol to take the edge off. When my nerve block wore off yesterday morning, I was crying in pain and despite asking, my tramadol doses only came 7-8 hrs after the last one (they need 2 nurses to sign for it and it was often hard to find another one to do it), meaning I had severe breakthrough pain that was then very tough to get on top of. My husband was horrified when he came in and saw the state of me. I was discharged yesterday afternoon and thought well at least I can now take my pain meds on a proper schedule.

I suffer from adenomyosis and cripplingly painful periods, and I've had several surgeries so I understand some post-op pain is normal, but this is another level of pain and I can barely get it to a manageable level. I've usually coped overnight with a bedtime opiate plus OTC painkillers, but I've woken in severe pain after 5 hours. I'm taking ibuprofen, paracetamol and tramadol at the intervals indicated, although 4 doses in 24 hours seems to go quickly. Can't use ice as it won't penetrate the thick cast.

My knee ligament repair a few years back was bloody agony but this is another level, maybe due to the broken limb as well. Anyone else who has had surgery on a broken bone, how long until the pain reached manageable levels? I'm just sat quietly sobbing right now while DH sleeps peacefully ( he has been brilliant so I don't begrudge him his sleep). Going slightly mad and still heartbroken that our beautiful honeymoon was cut short by all this pain.

It took me about 10 days after I broke my ankle, a double spiral fractured fibula. You need to remember that they will in effect have had to retreat any previous healing to realign the bones, then drilled & plated it, plus pulling all the muscle & tendons to fit the plates. Can you ask your GP for Naproxen instead of the Ibuprofen? They are a bit stronger & if the tramadol aren't working you may be better with oramorph & dihydracodeine, just ask for adequate pain relief, explain the pain hasn't reduced. Are you keeping your arm in a sling? At night you may be better laying on your opposite side & resting your pot on a pillow.

**rebreak

You can up the paracetamol to co-codamol, available at any pharmacy. That's a mixture of codeine and paracetamol.

Agree with pp that naproxen is good although they may be reluctant to prescribe if you have asthma. GP will help there.

You might need to experiment a bit to find the most comfortable position to sleep in. I bought a lot of extra pillows.

Retired nurse...but not orthopaedic..

I completely agree with you OP that this level of pain management is totally inadequate. I'd either contact fracture clinic (or the ward) or get yourself an urgent GP appointment.

I don't know if such pain is normal after this surgery, but I do know you shouldn't be having to put up with it.

Hope you get sorted

@Nat6999 Thanks for replying, yes now you've set out what they would have done in the surgery, the massive pain totally makes sense. I'll ask GP about naproxen and the other ones, thanks. Bit nervous about taking it due to increased risk of stomach side effects, but I might just have to. I'm keeping my arm upright, propped on pillows as hospital said I had to for first few days to reduce swelling but it's so uncomfortable. Will ring when they open and see what can be done. The hospital didn't seem to get how much pain I was in.

@Octavia64 If I'm already taking other opiates I'm not sure I can have co-codamal but can check with GP.

Thanks @Houseplanter appreciate you saying that, honestly think I could have done with a morphine pump in hospital.

With naproxen, they can give you omeprazole which will help protect your stomach. If you take it with food as well that will help.

I was on tramadol, codeine and naproxen.

I had a particularly bad ankle break and was in a cast for three months.

So sorry you've had all this to tolerate. Sounds hideous!

It sounds as if you've had seversl.very.painfil surgeries (my acl repair decades ago was bloody agony - in the end I was on morphine driver 😬).

I know protocols have changed irt pain management for post operative pain... There.was research some years ago saying ibuprofen /paracetemol worked as well as opiates (😂), I was advised this when I was in mad levels of post op orthopaedic pain😭.

Whichever protocol you're on it's clearly not working for you... You NEED rest to heal!

Today, as soon as your GP surgery is open please refer yourself urgently, if only by phone- that level of pain you shouldn't have to tolerate -

I've always used the phrase 'it's unethical to leave me in this much pain-I need better/more appropriate pain relief now please ',

Also in parallel I would call the hosp given that it is so recent... Although suspect they'll bounce you to primary care.

If you're not up to being assertive with them - and with that much pain, you prob are really struggling marshaling your thoughts - get your husband /friend to intervene?

I'm sure it will be so much better once you have a better protocol/decent relief.

Good luck! ❤️

Also, to help sleep I lined them up rather than alternating if you know what I mean.

So I'd take tramadol and paracetamol and neurofen at bedtime.

I also found a hot bath helped - you can get cast covers. (Highly recommended)

Please get this reassessed to ensure there isn’t swelling under your cast that is too tight. It can cause huge complications. Please go to A&E now. Earlier you go usually quicker it is x

PS sorry my reply has cross posted with several others saying similar stuff!

Actually if it's not considerably improved - this is good advice!

Thanks for the lovely and kind replies, it's meant a lot when I'm sat here in early hours of morning.

@Strugglingmumof3 The ward did advise me to be aware of swelling, but they said it was ok as long as my fingers looked a normal colour, which they do. Just noticed my thumb is completely numb though, so I think I'll be calling them shortly just in case along with getting better pain meds from GP.

Came on to say the same thing as @Strugglingmumof3 . Now you say your thumb is numb- please go to ED asap for assessment!

You poor thing.
I also experienced similar inadequate pain relief. I was given just paracetamol. It took several days and many desperate nights to get the level of pain relief right. Someone came and gave me morphine in the very beginning but it was just once. After that they slowly upped my medication to Paracetamol, Codeine, Dihyrdrocodeine and finally the magic ingredient - Amitriptyline.
If you have damaged nerves like I did then ask your GP if Amitriptyline is appropriate.
Good luck, I hope you feel a bit better today.

Be aware of trapped/damaged nerves too, (can happen during some repairs) if the pain doesn't settle then this could be a differential for on going severe pain.

Re the naproxen you can also get enterically coated tablets which should reduce the risk to your stomach as well.

@fridaynight1 You poor thing, that sounds terrible ❤️.

Tried the ward a few times but didn't manage to get through to them so I'm at A & E now (we live 5 mins from the hospital which is quite handy). Hopefully not too long a wait, will come back and update.

Aw, I'm sorry that you had to cut short your lovely honeymoon.

I hope A&E can sort out your pain.

I was also going to suggest either nortriptyline or amitriptyline if there is nerve involvement.

Speak to GP. You read a lot, for many people, that their level of pain management is totally inadequate. It's so poor isn't it? Why is this allowed to happen?

I broke my back in 4 places, and was in so much pain I was shocked. Later an MSK associate told me paracetamol should be enough. The osteoporosis nurse I later spoke to was horrified at his suggestion.

@Oblomov24 I think there's a culture of putting up with things, and the US opioid crisis has made the NHS understandably wary of how they prescribe stronger painkillers. Plus the mentioned studies on OTC painkillers.

I don't think we should be giving potentially addictive painkillers out like candy the way they did in the US, but I've never had an issue tapering off them for severe pain. I think there's a lot of nuance between that situation and expecting people to cope on paracetamol for severe post op pain.

Wrist surgeon here. Be very strict to keep your hand higher than your elbow, ideally higher than your heart, and keep your fingers moving as fully as possible, using your other hand to stretch and bend them if necessary. This will reduce pain from swelling. Don't use a sling, as this stops you using the muscles in your arm which move fluid around. Keep elbow and shoulder moving fully.

Sometimes you can develop acute carpal tunnel syndrome after a wrist fracture- if your thumb numbness doesn't settle with elevation you need to ring the consultant secretary/trauma nurses/fracture clinic and ask for an appointment soon (within a week usually).

The other thing that occasionally happens is swelling under the cast. Presumably it's a backslab with a soft part down one side. The plaster room in fracture clinic will usually look at this for you. Rather than mess around with minor injuries/A&E ring the plaster room/fracture clinic and they will often see you directly to assess/change.

Try to take your painkillers regularly and as evenly spaced as sleep allows. 2 paracetamol (1g) 4 times a day, 400mg Ibuprofen 3 times a day (watch out for tummy pain). You could switch out paracetamol for co-codamol if needed, especially at bedtime.
At night, sleep on your back with a pillow on your chest and hand on the pillow (elbow on mattress by your side). It's difficult, I'm sorry. It gets much better from 7 days.

Pain management is always underestimated , it's not like they've not had long to practice the skill...

@Lokshen Thanks for all the info. Yes, am absolutely being strict with keeping arm upright and hand higher than elbow at all times and making sure I move fingers and arm. The sling is a padded one, I don't wear it round my neck but it helps me keep elbow bent and hand pointing up.

Will keep an eye on the numbness issue and see what the ortho person in A & E says. The usual pain relief just isn't doing it for me and I'm taking it all on schedule so I'll have to get something else.