OVERVIEW
Unorganized notes:
- Minimize opioids, maximize non-narcotic interventions
- Talk to the patient – set expectations
- ALL patients can get Tylenol – even patients in compensated liver failure. X dose Q6h scheduled. For healthy person, 4g/day (1000mg/q6). For kind of unhealthy 3g/day, compensated cirrhotic patient 2g/day
- NSAIDs – most patients can have Toradol (not Dr. Kim’s patients). Always ask the attending about toradol!! 15/30 q6h. Don’t use in renal dysfunction, gastric mucosa issues, gastrectomy, etc.
- PO – ibuprofen 300-800 q6, up to 3200/day. naproxen, diclofenac 40mg q6-8 or TID with food
- Gabapentin – use for large incisions, peripheral vascular disease, painful calf incisions, thoracic incisions. 300 TID. Worried about delirium? Use 300 qHS/BID. 100qHS if high risk of delirium
- Lidocaine patch – qdaily. Place AROUND incision not on it. Specify this in orders
- Tramadol – opiate but lower addiction potential. Lower delirium potential 50 q6, healthy 100 q6h. mx 400/day
- Epidural – infusion local +- opiate. Can cause hypotension, usually fluid responsive and responsive to turning down rate of infusion. Infection. Hematoma. Changes to anti plt, anticoagulation, SQH – discuss with anesthesia first. Anesthesia manages. Monitor pain levels after removal of epidural.
- Narcotics
- IV PCA – dilaudid 0.1 – 0.2mg q10-20 min
- IV PRN dilaudid 0.2-0.8 mg q2-3hr. morphine 5-10mg
- PO PRN oxycodone 5mg q4h
- Scheduled narcotics usually for patients who came in on scheduled narcotics
- DC meds
- Look at day before discharge and how much they used
- Norco – hydrocodone plus tylenol
Page Updated: 06.18.2018