"Pain management and care on the ward"

Late last year I had an extensive right forefoot reconstruction as a result of my rheumatoid arthritis (RA). The service that was provided to me up until the ward was amazing. The pre-op experience, surgical experience and PACU (post anaesthetic care unit) experience were all fantastic until I hit the ward. My anaesthetic was a spinal along with some local into the area. I was first on the pm list. My surgery was 2.5 hrs long and I left recovery around 1800. My spinal and local wore off around midnight. I was in terrible pain. The nurses were having some issues with another patient and around 3am, I buzzed for some pain relief. Endone does not agree with me, however it was all that was offered to me so I took this with an antiemetic. I continued to take the endone as prescribed and basically clock watching for my next dose. I was also on regular paracetamol, ibuprofen and tapentadol BD (twice daily).

After about the 3rd scheduled dose of endone, I began to feel very nauseated and vomited from the endone. After this I refused the endone as I was not able to tolerate it. My pain was 10/10, however not once was I asked by any nursing staff to rate my pain. I was admitted for 4 days and not once asked about my level of pain. After I refused the endone, this was not replaced with any other pain medication. I did however ask for some panadeine forte as I take this for my RA and knew I was able to tolerate this. When I asked for it again I was told that I couldn't have it as it was a stat dose. I was regularly asking for pain relief which to me indicates that the pain relief I was receiving was not adequate, yet I seemed no one bothered to consult with a resident or pain team. When up with the physio I almost passed out. My BP (blood pressure) was taken which was elevated, so clearly was not a vasovagul yet almost certainly due to pain. 

I had extensive reconstructive surgery to my toes and yet only once during my 3 day stay was my neurovascular signs checked.  

I am so disappointed with my pain management and the care I received on the ward. My pain was so poorly controlled which I thought would have been their area of expertise on an orthopaedic ward. 

Pain relief