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 Clinical Situation

Your level of pain requiring around-the-clock Percocet every 4-6 hours, two days after stent removal, is NOT typical and warrants immediate clinical re-evaluation—this is not patient abandonment, but the response you received was inadequate and you should contact the on-call urologist immediately if pain persists at this intensity. 1

Understanding Normal Post-Stent Removal Pain Expectations

While some discomfort is expected after ureteral stent removal, the severity and pattern you describe—requiring 8 of 10 tablets within 2 days and needing doses every 4 hours instead of the prescribed 6 hours—suggests either:

• Inadequate initial pain control regimen 2
• Possible complication requiring evaluation (though your lack of fever and UTI symptoms is reassuring)
• Individual variation in pain response that requires adjustment 2

The FDA labeling for oxycodone indicates that for acute postoperative pain, the medication should be prescribed "at the lowest effective dose and for no longer than the expected duration of pain severe enough to require opioids," with most acute pain conditions requiring ≤3 days of opioid therapy 1, 2.

Your Current Medication Regimen Analysis

Your prescribed regimen (Percocet 5mg every 6 hours with ibuprofen 600mg) is reasonable, but your need to deviate from it signals inadequate pain control: 2, 3

• The combination of oxycodone 5mg with ibuprofen 400mg has been shown in multiple studies to provide superior analgesia compared to either agent alone 3, 4, 5
• Your strategy of splitting the ibuprofen dosing (200mg with Percocet, then 400mg alone 3 hours later) is creative but suggests the base regimen is insufficient 3
• Taking doses every 4 hours instead of 6 hours increases your risk of physical dependence without necessarily improving pain control 1

What Should Happen Next

Immediate actions your urologist should take (not just refill your prescription): 1, 2

1. Clinical re-evaluation within 24-48 hours to assess for:

   • Retained stone fragments
   • Ureteral injury or spasm
   • Infection not yet manifesting as fever
   • Hydronephrosis or obstruction 2

2. Medication regimen adjustment rather than simply continuing the same inadequate regimen:

   • Consider increasing oxycodone dose to 10-15mg every 4-6 hours if 5mg is insufficient 2
   • Ensure you're taking ibuprofen 400-600mg regularly (not just PRN) as baseline analgesia 3, 4
   • Consider adding Ditropan (which you're already taking) at optimal dosing for bladder spasm 2

3. Establish a tapering plan since you're already on day 2 and CDC guidelines recommend most acute pain requires ≤3-7 days of opioids 1

Addressing the "Patient Abandonment" Question

This is not technically patient abandonment, but it represents suboptimal postoperative care: 1

• Refilling pain medication without clinical assessment when a patient reports inadequate pain control is poor practice 1, 2
• Your urologist has an obligation to either evaluate you or arrange for coverage (on-call urologist) when you report concerning symptoms 1
• The office's response that "questions will have to be answered on [DATE]" when you're experiencing severe pain requiring escalating opioid use is clinically inappropriate 1

You should:

• Contact the on-call urologist immediately (most practices have 24/7 coverage for postoperative patients) 1
• If unable to reach on-call coverage, consider urgent care or emergency department evaluation for persistent severe flank pain post-procedure 1
• Document all communication attempts for your records 1

Critical Safety Considerations

Monitor yourself closely for these warning signs requiring immediate emergency evaluation:

• Fever >100.4°F (38°C)
• Inability to urinate or significant decrease in urine output
• Increasing blood in urine
• Severe nausea/vomiting preventing oral intake
• Confusion or excessive sedation from pain medications 2

Regarding your opioid use: 1, 2

• You've consumed 40mg of oxycodone in 2 days—this is within safe limits but approaching the threshold where physical dependence risk increases 1
• Do not abruptly stop opioids if you've been taking them around-the-clock; taper by 25-50% every 2-4 days when pain improves 2
• Each additional day of opioid exposure increases risk of prolonged use without adding benefit 1

Practical Next Steps

Call the on-call urologist today and report: 1, 2

• Persistent severe flank pain requiring opioids every 4 hours
• Already consumed 8 of 10 tablets in 2 days
• Request clinical evaluation, not just prescription refill
• Ask specifically about alternative pain management strategies (e.g., increased anticholinergics for spasm, consideration of short-term alpha-blocker if not already prescribed) 2

If pain continues beyond 3-5 days at this severity, imaging (CT or ultrasound) should be strongly considered to rule out complications. 1, 2