What preoperative instructions should be given to a patient on hydrocodone (hydrocodone) and Tylenol (acetaminophen) 5-325 mg, with a cataract medication (possibly an antihistamine) for itching, prior to emergency foot surgery?

From the Guidelines

The patient should stop taking hydrocodone-acetaminophen 6-8 hours before surgery to minimize anesthesia complications and bleeding risk, as recommended by the Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement 1. The antihistamine for eye itching should be discussed with the anesthesiologist but can typically be continued until surgery. The patient should bring a complete list of all medications, including over-the-counter drugs and supplements, to the hospital. They should remain NPO (nothing by mouth) for at least 8 hours before surgery, except for essential medications which can be taken with small sips of water. If the patient has chronic pain requiring regular hydrocodone, the surgical team should be informed to ensure appropriate pain management during and after surgery. These precautions help prevent drug interactions with anesthesia medications, reduce the risk of respiratory depression, and minimize potential bleeding complications during emergency foot surgery. Some key considerations for postoperative pain management include the use of acetaminophen in a multimodal regimen, which has been shown to be a valid and effective option for improving outcomes and patient satisfaction while reducing opioid-related complications 1. Additionally, the use of gabapentinoids, alpha-2-agonists, and NSAIDs may be considered as part of a multimodal analgesia approach, but their use should be carefully evaluated in the context of the patient's individual needs and medical history. It is also important to note that the patient's current medication regimen, including hydrocodone and acetaminophen, should be taken into account when developing a postoperative pain management plan. The patient's surgical team should be informed of their chronic pain history and current medication use to ensure that appropriate pain management strategies are implemented during and after surgery. By taking a comprehensive and multidisciplinary approach to pain management, the patient's risk of complications and discomfort can be minimized, and their overall quality of life can be improved. The use of ketamine, dexmedetomidine, and other medications may also be considered in certain cases, but their use should be guided by the latest evidence and clinical guidelines 1. Ultimately, the goal of postoperative pain management is to provide effective and safe analgesia while minimizing the risk of complications and promoting optimal recovery and outcomes.

From the FDA Drug Label

Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see WARNINGS] Initiate the dosing regimen for each patient individually, taking into account the patient's severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see WARNINGS] Follow patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases with hydrocodone bitartrate and acetaminophen tablets and adjust the dosage accordingly [see WARNINGS] Do not abruptly discontinue hydrocodone bitartrate and acetaminophen tablets in patients who may be physically dependent on opioids.

The patient should be advised to:

• Continue their current medication regimen as prescribed, but with caution and close monitoring for signs of excessive sedation and respiratory depression.
• Notify their surgeon and anesthesiologist about their current medication use, including hydrocodone and Tylenol, as well as their cataract medication.
• Follow the recommended dosage and not exceed the maximum daily dose of 8 tablets (for 5 mg/325 mg) or 6 tablets (for 7.5 mg/325 mg or 10 mg/325 mg).
• Be aware of the risks of withdrawal and not stop taking their medication abruptly.
• Be closely monitored for signs of opioid-related adverse reactions, such as respiratory depression, and report any concerns to their healthcare team 2.

From the Research

Preoperative Instructions for Patient on Hydrocodone and Tylenol

The patient is scheduled for emergency foot surgery in three days and is currently taking hydrocodone and Tylenol (acetaminophen) 5-325 mg, as well as a cataract medication (possibly an antihistamine) for itching.

• The patient should be advised to continue taking their current medications as prescribed by their doctor until the day of surgery, unless otherwise instructed by their surgeon or anesthesiologist 3.
• It is essential to inform the patient about the potential risks associated with taking opioids, such as hydrocodone, including respiratory depression, especially when combined with other sedative medications 3, 4.
• The patient should be educated on the importance of pain management after surgery and the various options available, including non-opioid analgesics, such as naproxen sodium, which may be a preferred alternative to opioid combinations for acute pain 5.
• The patient's medical history, including their current medications and any allergies, should be thoroughly reviewed to minimize the risk of adverse reactions during surgery 3, 6.

Medication Management

• The patient's current medication regimen, including hydrocodone and Tylenol, should be carefully evaluated to determine the best course of action for perioperative pain management 3, 6.
• The patient may need to be tapered off their current opioid medication or switched to a different medication to minimize the risk of respiratory depression and other adverse effects 4.
• The use of adjuvant non-opioid analgesics, such as gabapentin, may be considered to enhance pain control and reduce the need for opioids 7, 3.

Surgical Preparation

• The patient should be instructed to follow a clear liquid diet for a specified period before surgery and to avoid eating or drinking anything for a certain number of hours before the procedure.
• The patient should be advised to arrive at the hospital or surgical facility at the designated time and to bring all relevant medical documents and medications with them.
• The patient's surgeon or anesthesiologist will provide specific instructions on how to prepare for surgery and what to expect during the procedure.