“OK, just relax,” the nurse said as she pressed the suppository in. “We need to get it in deep so it doesn’t slip out…”
It was two days since my ankle surgery. 1am in the morning. My ankle was threatening to burst out of the splint and gauze. A throbbing, ever-present ache that was robbing me of sleep.
I’d been on a baseline 60mg loxoprofen pills three times daily since the surgery, but this would wear off around midnight. Lying in the dark with nothing to focus on but the pain, it was too much to bear, especially if I had to go to the bathroom. The nurses had offered to administer suppositories as a breakthrough measure during the night, and this was the first time I’d taken them up on the offer.
It was only later that I’d discover that while suppositories are common in Japanese hospitals for extra pain relief, this is not necessarily the case elsewhere. So, here’s a list of all the pain medication I’ve received so far while in this current hospital stay.
List of Pain Meds
Here’s a list of all the pain medication I’ve received so far during this hospital stay at Shin-Sapporo Orthopedic Surgery Hospital in Sapporo City, Japan. I underwent ankle stabilisation surgery (three holes drilled through the base of my tibia and fibula and then fixation) after tearing ligaments in my ankle and fracturing my fibula in a skiing accident. Pain is notoriously subjective, but my subjective experience was still quite painful; few people will get three 10cm long holes bored through two bones, a 5cm incision, and the bone surface scraped clean, without the body later complaining about it quite spectacularly.
About me: I’m a 45-year-old Caucasian (New Zealand) male, 179cm tall, 79kg.
During Surgery (while under general anaesthesia)
- Nerve blockers (Levobupivacaine) – Via injection. This long-acting local anaesthetic was used to block nerves in lower leg during and after ankle surgery on the 12th of Feb. None since then (3 days ago). It wore off completely around 24hrs after surgery and threw me into the pain cave.
- Xylocaine (lidocaine, 100mg) – Via IV. This is a local anaesthetic.
- Ropion NSAID (flurbiprofen axetil, 50 mg) – Via IV.
After Surgery
- Loxoprofen NSAID (60mg) – Oral form. Baseline/scheduled pain medication. Taken three times daily while in hospital since the surgery, after meals.
- Ropion NSAID (50mg) – Via IV. I had this two times while I still had an IV port in my arm, to manage post-op pain as the nerve blockers wore off.
- Voltaren NSAID (50mg) – Suppository. As needed as a rescue/breakthrough med in addition to the loxoprofen.
There are a few things to note about pain meds at hospitals in Japan that might be different to other countries.
- The use of post-op opioids is very limited. Indeed, they didn’t even use any during the surgery. I asked a nurse why this is the case, given that fentanyl, morphine, and the like are used more readily in my own country of New Zealand, and certainly in the US – even handed out upon discharge. She suggested that regulatory pressures are stronger in Japan. She also felt there was a ‘national character’ side to it. Perhaps a stronger sense of stoicism expected of patients to put up with pain. “That said, perhaps the biggest difference is the focus on conservative pain management, rather than a die-hard push to get pain down to zero by all means possible,” she mused.
- The use of suppositories is widespread. While the main baseline pain management is via oral NSAIDs (loxoprofen seems to be quite standard), suppositories – most commonly diclofenac (Voltaren) – are common rescue/breakthrough measures. I don’t have any qualms with suppositories, and they can either be nurse-administered or self-administered. I’ve taken two so far. The first was nurse-administered, and another was self-administered. They act fast. For folk from countries where suppositories are a rare thing, I can see why it might be a bit of a shock. On balance, they’re definitely more convenient than having an annoying IV port in my arm on the off chance I might need a top-up. Why not more oral meds? Oral meds carry stomach irritation risk. Suppositories are a way to deliver more meds, but bypassing the stomach.
My thoughts
This injury and surgery has given me opportunity to reflect on pain and pain management. On the second night after having surgery, I only slept about three or four hours. The pain cave was deep! Realistically, only a 5 or 6 out of 10, but at night, when there’s not much else to focus on, it was forefront. Perhaps if I were in a different country, I would have had the option to smash that pain down to a 2 or 3 with opioids like fentanyl or morphine, and would have been able to sleep better. That would have been nice. That said, I did come through, despite having to put up with more pain than perhaps I would have put up with had I been in New Zealand.
I’ve also heard horror stories where people have been in Japanese hospitals with much more extreme pain than I endured, and have had to put up with rather ineffective NSAIDs. So, if you’ve had any experience with pain meds (or lack thereof) in hospitals in Japan, please drop a comment!
3 thoughts on “Hokkaido Ski Accident (Part 5): Japanese Hospital Painkillers”
Gamon.
My 12 year old son broke his arm in Hakuba. Great medical attention but it was reset with only 2 panadol. I gave him permission to swear and scream as 2 nurses his snowboard instructor and I held him down whilst the doctor stretched out his arm and set the bone.
However less than 5 minutes later my son was asking when could he ski and could we get Maccas.
I was in shock but he recovered quickly and skied no poles for the rest of the week.
Since then I have been amazed at his pain threshold. He played a basketball final with 2 broken knuckles from the semi final. Etc.
Gamon – be strong . I kind of see the reason behind the lack of pain relief.
That’s one tough kid! Yes, for sure there seems to be some logic in the conservative approach here.