From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
Dosage and Administation: 2. 1 Important Dosage and Administration Instructions Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions (5)] 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 and Precautions (5. 1)] . Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases with oxycodone hydrochloride tablets and adjust the dosage accordingly [see Warnings and Precautions (5.3)] . 2. 2 Initial Dosage Use of Oxycodone Hydrochloride Tablets as the First Opioid Analgesic Initiate treatment with oxycodone hydrochloride tablets in a dosing range of 5 to 15 mg every 4 to 6 hours as needed for pain. Titrate the dose based upon the individual patient’s response to their initial dose of oxycodone hydrochloride tablets Patients with chronic pain should have their dosage given on an around-the-clock basis to prevent the reoccurrence of pain rather than treating the pain after it has occurred.
To optimize pain management in postoperative patients, the following key points should be considered:
- Initiate treatment with oxycodone hydrochloride tablets in a dosing range of 5 to 15 mg every 4 to 6 hours as needed for pain 1.
- Titrate the dose based upon the individual patient’s response to their initial dose of oxycodone hydrochloride tablets.
- Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases with oxycodone hydrochloride tablets and adjust the dosage accordingly.
- Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals. Some important considerations for optimizing pain management include:
- The patient's severity of pain
- Patient response
- Prior analgesic treatment experience
- Risk factors for addiction, abuse, and misuse 1
From the Research
Optimizing pain management in post-neck of femur fracture (NOF #) requires a multimodal approach combining pharmacological and non-pharmacological strategies, with a focus on minimizing opioid use and related adverse effects, as recommended by the most recent and highest quality study 2.
Key Considerations
- Begin with regular paracetamol 1g every 6 hours as baseline analgesia, as it is well-tolerated and effective for mild to moderate pain 3.
- Add NSAIDs such as ibuprofen 400mg three times daily or naproxen 500mg twice daily if not contraindicated by renal impairment, heart failure, or bleeding risk, as they are effective for inflammatory pain components 3.
- For moderate to severe pain, consider introducing opioids like oxycodone 5-10mg every 4-6 hours or morphine 5-10mg every 4 hours, with careful monitoring for respiratory depression and constipation, as they are effective but carry significant risks 2.
- Consider nerve blocks such as fascia iliaca compartment block or femoral nerve block pre-operatively and post-operatively to reduce opioid requirements, as they can provide effective regional analgesia 4.
- Adjuvant medications including gabapentin 300mg daily (titrated up as needed) can help manage neuropathic pain components, as they are effective for chronic pain management 5.
Non-Pharmacological Approaches
- Regular pain assessment using validated tools ensures appropriate titration of medications, as it allows for tailored treatment plans 6.
- Non-pharmacological approaches including proper positioning, ice application, and early mobilization with physiotherapy support complement medication management, as they can reduce pain and improve functional outcomes 4.
Special Considerations
- Elderly patients require special consideration with reduced starting doses and more frequent monitoring due to altered pharmacokinetics and increased sensitivity to medication side effects, as they are at higher risk of adverse events 3.
- Patients with chronic pain or opioid use disorder require careful management, as they may require alternative treatment strategies and closer monitoring 5.