Managing Pain


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