Post-Appendectomy Pain and Recovery Challenges

Appendectomy for appendicitis?

Hello, doctor.
My boyfriend underwent laparoscopic appendectomy on July 1st around noon, and the surgery was completed by around 2 PM.
When I visited him at around 6 PM, he said, "The pain is unbearable." The nurse administered a strong painkiller, but after more than two hours, he was still in unbearable pain and had to ask the nurse for another painkiller (the nurse gave him a standard pain medication), but he continued to experience pain.
On July 2nd, when I visited him at around 6 PM, he was able to get out of bed and walk, but he mentioned that his abdomen had been very bloated all day.
Before I arrived, the nurse had given him a "gas relief injection," but he was still bloated to the point of discomfort.
As a result, the nurse administered a suppository, and his gastrointestinal tract seemed to be moving; he went to the bathroom twice, but both times he passed "white granules." I asked the nurse about this, and she said it was "intestinal mucosa." However, the suppository and the injection seemed ineffective, so the nurse gave him a bottle of something that seemed to be called "lactulose" (I'm not sure about the name, but its purpose is to aid in bowel movements).
After using the suppository and drinking the medication, he was able to get out of bed and walk, but the medication didn't seem to help much.
The nurse consulted the on-call physician, who asked my boyfriend if he wanted to have a nasogastric tube inserted.
My boyfriend agreed, and after the tube was inserted, approximately 200-300 cc of fluid was drained.
However, after that one instance, he did not expel any more fluid, yet he continued to complain that his abdomen felt extremely bloated, as if it were about to burst, and he also had significant pain in the upper abdomen.
The nurse came to check and decided to perform an X-ray, which confirmed intestinal distension.
I asked the nurse why other patients who had appendectomies recovered quickly while my boyfriend did not, and she said my boyfriend's case was more severe.

I would like to ask the doctor the following questions:
1.
Why is he experiencing persistent pain in the upper abdomen, to the point of requiring pain medication, and why does he breathe heavily when in pain?
2.
Why did the gas relief injection and suppository not lead to any gas expulsion?
3.
Why did the nasogastric tube only drain fluid once? Is it permissible to drink water before passing gas? When I visited on July 2nd, I saw him drinking water, and he said the nurse allowed him to drink half a cup of water every half hour, but he vomited after drinking.
However, he had not yet passed gas.
I've heard that one should not drink water before passing gas and should only moisten the lips with water on a cotton swab.
4.
Why is he experiencing a fever?
5.
What can be done to alleviate his pain and ensure he can be discharged safely?
I really need your help, doctor.
I don't know what to do.
Thank you.

Ms. Chen, 20~29 year old female. Ask Date: 2010/07/03

Dr. Lai Jihong reply Surgery

1.
Endoscopic surgery requires general anesthesia, which can affect gastrointestinal motility due to the anesthesia, leading to bloating and discomfort or pain in the abdomen.

2.
Generally, it takes about half a day to a day for normal motility to resume after surgery.
If there is no significant bowel obstruction, it should be acceptable to drink small amounts of water (less than 20cc) before passing gas.

3.
As for the fever, it depends on the actual condition.
It could be caused by postoperative secretions, urinary tract issues, a cold, or other reasons.
It would be more appropriate to consult your boyfriend's attending physician regarding this matter.
Wishing you safety and health!

Reply Date: 2010/07/03

More Info

Post-appendectomy pain and recovery challenges can be quite distressing, both for the patient and their loved ones. It’s important to understand that while many patients recover quickly from an appendectomy, some may experience complications or prolonged discomfort. Here’s a detailed response to your questions based on the information provided.

1. Why is his abdomen still painful?
After an appendectomy, it is not uncommon for patients to experience significant pain, especially in the upper abdomen. This pain can be attributed to several factors, including surgical trauma, inflammation, and the body’s response to surgery. The pain can also be exacerbated by gas buildup in the intestines, which is common after abdominal surgery due to the manipulation of the intestines during the procedure. If your boyfriend is experiencing severe pain that requires frequent doses of pain medication, it may indicate that he is experiencing complications such as an infection, bowel obstruction, or other issues that need to be evaluated by the medical team.

2. Why did the gas relief injections and suppositories not work?
The administration of medications to relieve gas and promote bowel movements can sometimes be ineffective, especially if there is significant postoperative ileus (a temporary cessation of bowel activity). This condition can occur after surgery due to the effects of anesthesia, pain medications, and the physical manipulation of the intestines. If the intestines are not functioning properly, gas can accumulate, leading to bloating and discomfort. It’s essential for the medical team to monitor this closely and consider further interventions if the situation does not improve.

3. Why did the nasogastric tube only drain a small amount of fluid?
The insertion of a nasogastric (NG) tube is often used to relieve pressure from the stomach and intestines. If only a small amount of fluid was drained, it may indicate that the obstruction is not severe, or that the intestines are beginning to function again but are still sluggish. It’s important to monitor the patient’s output and symptoms closely. Regarding drinking water, it is generally advised that patients avoid oral intake until they have passed gas or had a bowel movement to prevent further nausea and vomiting. However, if the medical team has cleared him to drink small amounts of water, it may be to keep him hydrated, but this should be done cautiously.

4. Why is he experiencing a fever?
Postoperative fever can occur for several reasons, including infection, inflammation, or even a reaction to the surgical procedure itself. It’s crucial for the healthcare team to assess the source of the fever, as it may indicate a complication such as an abscess or infection that requires treatment.

5. What can be done to alleviate his pain and ensure a safe discharge?
Pain management is a critical aspect of recovery. The medical team may need to adjust his pain medication regimen to provide better relief. Additionally, they should continue to monitor his bowel function closely and consider interventions such as physical therapy to encourage movement, which can help stimulate bowel activity. If the pain persists or worsens, further imaging studies may be necessary to rule out complications.

In summary, your boyfriend’s situation requires close monitoring and possibly further intervention by the medical team. It’s essential to communicate openly with the healthcare providers about his symptoms, pain levels, and any concerns you have. They are best equipped to make decisions regarding his care and ensure a safe recovery. If his condition does not improve, do not hesitate to advocate for further evaluation and treatment.

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