Advice for Gynae Pain
Hello fellow members of the gas board. Was hoping to get some tips regarding pain management in Gynae patients.
For context, I am a UK anaesthetist and work in a mid sized teaching hospital. This is my 5th year in Anaesthetics. As a centre, we have a notable/well renowned gynae service and it turns out I actually like providing an anaesthetic for this service. I like the variety of anaesthetic techniques and the discussions with patients. My colleagues generally do not like this service so I now get a lot of these lists.
One aspect that I'm finding difficult is judging pain requirements post operatively for these patients. I've had patients turn up for very routine / minimally invasive procedures who are in rip roaring pain afterwards that sometimes even require them to stay overnight. Nearly always, it is an intense cramping pain in the mid-lower abdomen.
My regular practice is roughly 0.1mg/kg of morphine as well as fentanyl on induction. I always give paracetamol (acetaminophen) and diclofenac. If I have time and the blood pressure allows I will also give magnesium. If the patient is very anxious I'll give a smidge if midazolam (Versed) if I don't think the procedure is going to be that painful or clonidone if it is. I do TIVA if it is a medium / long case.
Does anyone have any good tips or advice for this patient population? I have spoken to a few of my colleagues who seem to just say that not much can be done and it just happens with gynae patient's sometimes. In which case, what sort of discussion do you have with these patients post-operatively?
Thanks in advance and sorry for the essay!