Event 4: Courtney's Hospital Discharge

Courtney's Back at Discharge

Surgical scar shown at hospital discharge
Courtney's back

Discharge Medications

  • Oxycodone 5mg 1-2 q4h prn pain #100 
    • (suggest using 1 table q6h ATC for 1st week)
  • Diazapem 2mg q6-8h prn spasms 
    • (suggest using 2-3 times per day for 1st week)
  • Ibuprofen 400mg q4-6h prn pain 
  • Acetaminophen 650mg q4-6h prn pain
  • Miralax 1 capful daily for soft stool while on opioid
  • Dulcolax 100mg 2x daily 
  • Bisacodyl 5mg 1-2qd to assist in bowel evacuation 
  • Formal Physical Therapy for 2 weeks    

Courtney’s Discharge Instructions

Pain Control

  • First few days - encouraged to take oxycodone regularly to avoid developing severe pain
  • Encouraged to continue the use of ibuprofen and acetaminophen to control pain
  • Use diazepam (2-4mg every 6 hours) to treat spasms
  • Spasms are a major cause of postoperative pain
  • As pain improves, encourage lengthening the time between doses or reduce each dose taken of oxycodone until it is no longer needed for pain control


  • Continue to slowly increase walking and other activities multiple times per day as tolerated
  • Use pain medication if needed to facilitate increased activity


  • Continue Miralax daily to maintain soft stools until oxycodone is stopped 
  • Use docusate 100mg every 12 hours as needed and bisacodyl suppository every day as needed to promote bowel movements daily 

Courtney’s Post-Discharge Pain Concerns

  • Courtney was discharged 4 days after surgery
  • Courtney had a difficult time swallowing pills 
    • Solution: All of her meds were changed to liquid
  • Courtney was concerned about taking too much medication 
    • Instructed to decrease medications as tolerable over time 
    • Instructed to wait at least 2 hours between oxycodone and diazepam administration 
  • Courtney was concerned about ongoing muscle spasms
    • Instructed to continue to take oral diazepam daily every 6 to 12 hours until muscle spasms stop

Courtney’s Discharge Experience

6 Days Post Surgery: (day 2 after discharge)

  • Pain Control - Continued to take oxycodone regularly.  Occasionally took Oxycodone 7.5mg instead of 5mg if very uncomfortable (pain 7-9/10)
  • Muscle Spasms: Continued to take diazepam 2mg every 6-8 hours.  Occasionally she would take 4mg if spasms were not relieved by 2mg 

One Week Post Surgery

  • Pain was 4-6/10 during the day but she slept well using pain medication
  • Still taking oxycodone 5mg and acetaminophen 650 mg or ibuprofen 400mg every 4-6 hours
  • Spasm were common after walking or sitting up too long – continued on diazepam 2 mg every 6 hours
  • For her bowels, she used Miralax one capful every day

Two Weeks Post Surgery

  • Pain decreased to 2-6/10 during the day depending on the level of activity
  • Stopped taking oxycodone and used acetaminophen 650 mg or ibuprofen 400mg every 4-6 hours to control the pain
  • Continued to sleep well.
  • Spasm were less frequent and she took diazepam only as needed (rarely)
  • Miralax one capful continued at home every day

One Month Post Surgery

  • Pain had decreased to 0-3/10 and spasms had stopped
  • Continued to use acetaminophen 650 mg or ibuprofen 400mg once or twice a day only as needed to control pain
  • Started to have tingling sensations at top of incision (she was advised it was nerve regrowth) but did not need to treat.

Discharge Guidelines

  • Develop a discharge plan based on use of medication in the hospital to maintain adequate pain control
  • Given limited supply of opioids with a plan to refill them if needed after re-evaluation
  • Provide appropriate alternative medications including acetaminophen and non-steroidal anti-inflammatories
  • Involve parents in the administration and use of opioids with encouragement to adequately control the pain
  • Monitor for inappropriate use of opioid medication
  • Emphasize the need for adequate mobilization to promote function and reduce pain from muscle spasms
  • Encourage use of local therapies including heat, cold, and positioning
  • Continue bowel regimen until the patient stops opioid use
  • Encourage contact with health care provider for any concerns.
  • Consider early re-evaluation in person or by phone when patient or parental concern is present
  • Emphasize the appropriate disposal of unused opioid once pain has resolved

Courtney’s Home Care

How was your trip home from the hospital?

Courtney explains about her trip home from the hospital?

Did You have any Muscle Spasms?

Courtney explains whether she has any muscle spasms.

How Did Your Mom Help You?

Courtney explains how her mom helped her.


Courtney explains more about her experience taking opioids.

Pain Control at Home

  • Provide analgesics just prior to transportation
  • Encourage graded mobilization and use analgesics to treat resulting pain
  • Responsible adult should manage analgesics
  • Assist patient to prevent falls
  • Maintain bowel regimen during use of analgesics
  • Observe for fever or redness around the wound

Medications While on Opioids

  • Stool softener – Miralax, dulcolax
  • Motility agent – Senna, bisacodyl (also available as suppository)
  • Stomach protection
    • H2 blocker (e.g cimetidine or ranitidine)
    • Proton pump inhibitor (e.g. esomeprazole)

Instructions for Parents and Children

  • Target 1-2 soft stool per day
  • If stool is hard, increase stool softeners
  • If frequency is less than 1 per day, increase motility agent
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