Is persistent flank pain requiring frequent doses of Percocet (oxycodone) and ibuprofen, 2 days postoperative stent removal, a normal expectation for my postoperative recovery?

Postoperative Pain Management After Ureteral Stent Removal

Direct Answer to Your Concerns

Your level of pain requiring around-the-clock Percocet (oxycodone) at 2 days post-stent removal is NOT typical and warrants immediate clinical evaluation, not just a prescription refill. While some discomfort is expected, persistent severe flank pain requiring escalating opioid doses suggests a potential complication that needs assessment before simply continuing pain medication 1.

What Pain Level Should Be Expected

• For most acute postoperative pain not related to major surgery or trauma, pain severe enough to require opioids typically resolves within 3 days 1
• The CDC guidelines specifically state that "more than 7 days will rarely be needed" for acute non-surgical pain management 1
• Your pattern of needing medication every 4 hours (instead of the prescribed 6 hours) and already consuming 8 of 10 tablets in 2 days indicates inadequate pain control or a potential complication 1

Red Flags Requiring Evaluation

Your situation has concerning features that need clinical assessment:

• Persistent severe flank/kidney pain at 48 hours post-procedure - this location suggests possible ureteral irritation, stone fragment, or early obstruction rather than typical post-procedural discomfort 1
• Escalating analgesic requirements - needing doses more frequently than prescribed suggests either inadequate initial dosing or an evolving problem 1
• Blood clots in urine - while occasional small clots can be normal, combined with severe pain this warrants evaluation 1

Regarding Patient Abandonment Concerns

Your urologist's response does not constitute patient abandonment, though it is suboptimal care. Here's the clinical reality:

• Providing a refill addresses your immediate symptom (pain) but fails to evaluate whether your pain represents a complication 1
• The appropriate response should have been: assessment of whether your pain level is appropriate, evaluation for complications, and then pain management adjustment 1
• Most practices have on-call coverage for postoperative concerns - you should call the main office number and ask for the on-call urologist 1, 2

What Should Happen Next

You need clinical evaluation before simply continuing opioids, ideally within 24 hours:

• Contact the on-call urologist through the main office line - explain your escalating pain requirements and flank location 1
• Request evaluation for potential complications including residual stone fragments, ureteral injury, or early obstruction 1
• If you cannot reach on-call coverage and pain worsens, consider urgent care or emergency department evaluation 1

Appropriate Pain Management Strategy

If complications are ruled out and this is determined to be severe but expected post-procedural pain:

• The combination of oxycodone 5mg with ibuprofen 600mg is evidence-based and appropriate - studies show oxycodone/ibuprofen combinations provide superior analgesia to either agent alone 3, 4, 5
• Your strategy of splitting the ibuprofen dosing (200mg with Percocet, then 400mg 3 hours later) is reasonable to maintain anti-inflammatory coverage while staying under the 2400mg/24hr limit 3
• However, needing doses every 4 hours suggests the 5mg oxycodone dose may be inadequate for your pain severity 1, 2

Common Pitfalls to Avoid

• Do not accept ongoing opioid refills without clinical evaluation when pain is not following the expected trajectory - this delays diagnosis of complications 1
• Do not exceed 2400mg ibuprofen in 24 hours - you appear aware of this limit, which is appropriate 3
• Do not exceed 4000mg total acetaminophen daily - if your Percocet contains acetaminophen (typically 325mg per tablet), factor this into any additional acetaminophen use 2
• Ditropan ER (oxybutynin) can cause urinary retention - ensure you are voiding adequately, as retention could worsen flank pain 1

What Adequate Postoperative Care Should Include

Based on CDC opioid prescribing guidelines, your urologist should:

• Evaluate you to confirm or revise the initial assessment when pain continues longer than expected 1
• Re-assess whether benefits outweigh harms before continuing opioids beyond the initial prescription 1
• Optimize non-opioid therapies including ensuring adequate NSAID dosing and considering adjuncts like the Ditropan you're already taking 1, 2

Bottom Line

Call the main office number and request to speak with the on-call urologist today. Explain that you have severe, persistent flank pain requiring escalating opioid doses at 48 hours post-stent removal. This clinical picture warrants evaluation, not just prescription refills. While the office provided medication, they failed to address whether your pain level indicates a complication - which is the more important clinical question 1.