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Miscarriage misoprostol pain relief

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  • Miscarriage misoprostol pain relief

    I recently underwent medical management for miscarriage and was given Misoprostol vaginally (4 tabs initially, then 2 tabs). Within 4 hours I was experiencing EXCRUIATING pain. Doctor said it would be "bad period"- it was more close to labour pain.

    Nurses tried initially paracetamol 1g + codeine 30mg- done nothing
    Then given Codeine 60mg- done nothing
    Then given tramadol 50mg- Worked excellent and was able to rest. However pain relief lasted for approx 2 hours

    Hospital pharmacist came told her tramadol worked but not codeine. She said stick to tramadol if case. Nurse said pharmacist shouldn't have said that as we need to work in a stepwise ladder.

    Agonising pain started again;
    Nurse gave paracetamol + codeine again- declined as made no difference
    Nurse gave oramorph 5mg liquid- no difference to pain; just caused vomiting (even though doctor said to nurse give morphine injection)
    Nurse gave IV paracetamol; no difference
    Within an hour nurse then gave tramadol 50mg again; finally pain ceased and went to sleep

    My frustration is why nurses are so damn insistent on paracetamol when it clearly isn't working?! Also for future reference if you are used to taking stronger painkillers like opioids, amitriptylline, NSAIDs could that be the reason mild painkillers no longer work?

    I went through 12 hours of hell with this pain, however it definitely gives me a more realistic expectation of labour pain and perhaps I definitely need to think of a good pain relief plan.

    Any thoughts on this pain management?



  • #2
    What a dreadful experience, right through. Every sympathy. The nurse was clearly following the rules without thinking about how they were working. There’s an old adgae 'Rules are for the obswrvance of fools and the guidance of wise men.’
    In other words if in doubt, follow the rules, but that doesn’t mean they have to be slavishly followed. Medicine, in it’s widest sense, is an art, not a science, if by science we mean something where mathmatecal principles can be applied.

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    • #3
      I watched "Sully" yesterday. If he had followed the rules, 155 people would have died.
      johnep

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      • #4
        I am so sorry you have been through such a dreadful experience. I was lead pharmacist in a tertiary referral women's hospital. All I can say is I trained my nurses to use their common sense... if I had been the pharmacist I would have discussed it with the nurse and made a note on the drug chart. Frankly very few nurses would go against what I suggested!! (There s a reason I call myself DRAGONlady!!!!) To be fair Paracetamol IS the main painkiller with or without Codeine in obstetrics and gynaecology but if there was a prescription for Tramadol I cannot see why they made such a fuss about it. Some nurses are jobsworths I am afraid......I do hope you are getting the support you need after your miscarriage.

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        • #5
          When I was in Export had a letter from a hospital in West Africa begging us to send them some pethidine for their maternity wards. Said they only had aspirin. I had to reply that they would have to go through the correct channels and that our local agent would advise. However, heard no more.
          johnep

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