Triggered
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Saturday was a painful day. Pain at rest which woke me at midnight Friday night after the block wore off. No incisional pain, however. It's a really small incision, about 1 cm long. Tendon is all banged up, and any kind of motion was painful as well. I did my best to do the exercises (flex and extend) the fingers, but it really hurt.
Yesterday, Sunday was remarkably better. No pain at rest, and by end of the day, motion was limited by stiffness and swelling rather than pain.
This AM, no pain at all again. Stiffness is better, and I'm able to type as though nothing had happened.
But, here's why I'm following up.
Years ago, we were approached by a drug salesman who was touting Ofirmev, a new formulation of acetaminophen, Tylenol. It was high-dose, a gram, and to be given intravenously for pain control, and as a supplement during anesthesia. Being the curious type, I was eager to try it, and I was amazed at how well it worked. I found myself giving much less narcotics during surgery, and patients seemed to require less in the recovery period as well. The dose was 1 gram, intravenously, every 6 hours.
The major drawbacks to it were twofold:
- this formulation was expensive, and the hospital didn't want us using stuff that expensive (I think it was $25 a dose), when cheaper stuff (morphine) was available. Never mind that one of the advantages was less opiod use and fewer complications because of that.
- It made your liver fall out. Well, if doses were too high, it caused hepatotoxicity, so you were limited to 4 doses per day.
And then something interesting happened. People started looking at the effectiveness of acetaminophen when given orally, but in large doses - again 1 gram every 6 hours. It works just about as well as the intravenous route, and is dirt cheap.
So, in preparation for my procedure, I loaded a gram about 3 hours beforehand, and then got on a 6,12,6,12 schedule. It worked like a charm. When it wore off at midnight Friday night, that's what woke me. I took a dose, and I was pain-free in an hour, and slept until 5:30, when I needed another dose. I continued it through Saturday and Sunday. Worked great.
Today, I have no need for it, so I'm done.
Amazing drug.
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On a related note...What about the 650mg extended release acetaminophen pills? Better, same or worse?
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On a related note...What about the 650mg extended release acetaminophen pills? Better, same or worse?
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Day 10 post-op.
Negligible pain, unless I fall asleep with my fingers flexed. Then, it takes some effort to flex them more and then extend them.
I'm somewhat disturbed by the fact that I still have some pain on the dorsal (back) of the affected finger, but function seems good, although I can't extend it as far as the other three fingers.
Wound looks good. No drainage, no pus. Minimal swelling. I have no dressing applied, and the sutures come out Thursday morning.
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I use the extended release Tylenol now and then. Pretty good, much better with some ibuprofen. Luckily it’s only once every few months. My arthritis is very well controlled by meds.
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I use the extended release Tylenol now and then. Pretty good, much better with some ibuprofen. Luckily it’s only once every few months. My arthritis is very well controlled by meds.
@mik the high dose acetaminophen is amazing for acute pain. One gram every 6 hours. Mrs. George has had dental extractions and (!) a joint replacement using little more than that for analgesia.
Don't exceed the dose, supplement with opioids and anti-inflammatories (which acetaminophen is not!) as needed.
As I've said before, I was impressed with the intravenous route for this drug, and now, it seems that the oral is just as effective.
If you can take it prophylactically, all the better.
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G George K referenced this topic on
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So, about 8 months ago, I started having symptoms on the ring finger of my RIGHT hand. Pain and "catching." I had it injected in June, and got a good response.
Then, about 3 months ago, it started catching again. Not bad enough to require intervention, but just annoying enough. 6 weeks ago, my right thumb started to trigger. This was accompanied by pain, and, in the last few weeks interfered with my trying to play piano.
I saw the hand guy yesterday and he injected both fingers.
"So, you've done the ring finger twice now. What happens when/if this recurs?"
"Chop chop." (He actually said that)
"Fuck (I actually said that). If you operate on the ring finger, and my thumb acts up again, as I expect it will, do you have to do a second injection, or can you do both fingers at once, just to save me the extra trip to the OR?"
"Yeah, we can do both. See you in the fall. I'll have them wipe the blood and rust off the scalpels. I'll be waiting for you."
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LOL Hope that the injections work for a long time!!
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I have arthritis.
Just over 6 months ago I got a cortisone shot in the left thumb metacarpal. It worked ok.
Now the pain is coming back.
They said I could get 3 shots separated by about 6 months. If it is still hurting, then they'll remove the Trapezium and toss it in the trash.
Then they'll rebuild the lost support by rearranging some tendons.I haven't investigated exactly how this surgery works yet; I was hoping the cortisone would last longer.
