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Hip Fracture, Lower Hip, Back Pain, Cannot Move. Fentanyal Pca Discontinued, Morphine Given. Previous Lower Disc Prolapse. Advise?
my 33 yo daughter was crushed by her horse when it fell on her.she has a r hip fracture of acetabulum,being trated in hosp conservatively.
she is now 4 days post trauma cannot move herself in bed,incredible pain in hip and lower back.has been on fentenyal pca which was discontinued 12 hrs ago.
was put onto a long acting and short acting pain med but still in lots pain @ a 8/10 level.5 hrs ago they had to give her morphine for pain.
she has had lower disc prolapse when training2 years ago,she was an olympic swimmer and is also a personal trainer,who regular spin classes.so is super fit
my concern is the level of pain that continues,has something been missed.
my issue is the hosp didnt ct scan her lower spine,
she is now 4 days post trauma cannot move herself in bed,incredible pain in hip and lower back.has been on fentenyal pca which was discontinued 12 hrs ago.
was put onto a long acting and short acting pain med but still in lots pain @ a 8/10 level.5 hrs ago they had to give her morphine for pain.
she has had lower disc prolapse when training2 years ago,she was an olympic swimmer and is also a personal trainer,who regular spin classes.so is super fit
my concern is the level of pain that continues,has something been missed.
my issue is the hosp didnt ct scan her lower spine,
Wed, 28 Aug 2013
Hello.
Thanks for writing to us.
The pain after a back injury is often severe as it can cause a nerve root compression and the nerve root irritation. The pain killers that you are already taking should be sufficient. Do consult a pain specialist for further advise.
I hope this information has been both informative and helpful for you.
Regards,
Dr. Praveen Tayal ,
drtayal72@gmail.com
Thanks for writing to us.
The pain after a back injury is often severe as it can cause a nerve root compression and the nerve root irritation. The pain killers that you are already taking should be sufficient. Do consult a pain specialist for further advise.
I hope this information has been both informative and helpful for you.
Regards,
Dr. Praveen Tayal ,
drtayal72@gmail.com
I find this answer helpful
Hi,
I understand your concern relating to the lack of a CT of your daughter's lumbar spine. I agree this would be advisable to assess the severity of her disc prolapse and to rule out any other injury that may be contributing to her severe pain.
Regarding her pain relief, you don't mention the specific drugs which she is currently prescribed but these are clearly not adequate. If I was involved in her care I would consider paracetamol and ibuprofen regularly and I would re-start the PCA. There is no reason why this should not be restarted as her pain level of 8/10 is now unacceptable. She had a fentanyl PCA but morphine can also be used as a PCA and is effective in these situations. If this still proves inadequate I use an infusion of ketamine instead of the morphine PCA. Ketamine can provide excellent pain relief without the sedating effects of morphine.
I hope this is of help to you. I wish your daughter a speedy recovery.
Regards,
Dr K A Pottinger,
MBChB FRCA
I understand your concern relating to the lack of a CT of your daughter's lumbar spine. I agree this would be advisable to assess the severity of her disc prolapse and to rule out any other injury that may be contributing to her severe pain.
Regarding her pain relief, you don't mention the specific drugs which she is currently prescribed but these are clearly not adequate. If I was involved in her care I would consider paracetamol and ibuprofen regularly and I would re-start the PCA. There is no reason why this should not be restarted as her pain level of 8/10 is now unacceptable. She had a fentanyl PCA but morphine can also be used as a PCA and is effective in these situations. If this still proves inadequate I use an infusion of ketamine instead of the morphine PCA. Ketamine can provide excellent pain relief without the sedating effects of morphine.
I hope this is of help to you. I wish your daughter a speedy recovery.
Regards,
Dr K A Pottinger,
MBChB FRCA
I find this answer helpful
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