What medications can be used for postoperative pain control?

From the Guidelines

Postoperative pain control should involve a multimodal approach, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, with adjuvant medications and local anesthetics as needed, as recommended by the most recent and highest quality study 1. The medications that can be used for postoperative pain control include:

• Acetaminophen (325-1000mg every 6 hours) as a foundation for mild pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg every 6-8 hours) or ketorolac (15-30mg IV every 6 hours for short-term use) to reduce inflammation and provide additive pain relief
• Opioids such as oxycodone (5-10mg every 4-6 hours), hydrocodone (5-10mg every 4-6 hours), or morphine (2-4mg IV every 4 hours) for moderate to severe pain, to be used at the lowest effective dose for the shortest duration due to side effects and addiction potential
• Adjuvant medications like gabapentin (300-600mg three times daily) or pregabalin (50-100mg twice daily) to help with neuropathic pain components
• Local anesthetics such as lidocaine patches or regional nerve blocks to provide targeted relief
• Other medications like dexmedetomidine, ketamine, and cyclo-oxygenase-2-selective inhibitors may also be considered in specific cases, as recommended by studies 1. It is essential to note that the choice of medication and approach should be individualized based on the patient's specific needs, medical history, and the type of surgery performed, and that pain medication should be scheduled rather than given as needed during the immediate postoperative period, with a plan to taper as healing progresses 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Ibuprofen tablets contain ibuprofen which possesses analgesic and antipyretic activities. Controlled studies have demonstrated that ibuprofen tablets are a more effective analgesic than propoxyphene for the relief of episiotomy pain, pain following dental extraction procedures, and for the relief of the symptoms of primary dysmenorrhea

The medications that can be used for postoperative pain control include:

• Ibuprofen: an analgesic that has been shown to be effective in controlling pain and inflammation, and is comparable to aspirin in controlling pain.
• Morphine: an opioid analgesic that can be used for pain control, but its use requires careful consideration of potential interactions with other medications and side effects.

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From the Research

Medications for Postoperative Pain Control

The following medications can be used for postoperative pain control:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 4, 5, 6
• Acetaminophen (paracetamol) 5, 6, 7
• Gabapentinoids (e.g. gabapentin, pregabalin) 5, 6
• Glucocorticoids 5, 6
• COX-2 inhibitors 4, 5
• Opioids (e.g. oxycodone, hydrocodone, tramadol, morphine) 5, 8, 6
• Local anesthetics (e.g. lidocaine) 6
• α2-adrenergic receptor agonists 6
• N-methyl-D-aspartate receptor modulators 6

Considerations for Medication Use

When using these medications, the following considerations should be taken into account:

• NSAIDs and COX-2 inhibitors should be used with caution in colorectal surgery due to the increased risk of anastomotic leak 4
• Gabapentinoids and glucocorticoids may have analgesic effects, but their use requires further clarification 5
• Combination regimens of non-opioid analgesics may be effective, but their use requires further investigation 5
• Opioids should be used judiciously due to the risk of addiction and side effects 6
• Multimodal analgesia, which combines different classes of medications, is recommended for effective postoperative pain control 8, 6, 7