From the Guidelines
Effective pain management in post-operative patients should prioritize a multimodal approach, combining medications and non-pharmacological strategies, with a focus on minimizing opioid use and preventing opioid-related harm, as recommended by the most recent guidelines 1.
Key Recommendations
- A tiered analgesic regimen is recommended, starting with scheduled acetaminophen and NSAIDs as baseline therapy, with opioids used as rescue analgesics only when necessary 1.
- Regional anesthesia techniques, such as peripheral nerve blocks, can provide targeted pain relief for specific surgical sites, and are recommended for patients with high expected postoperative pain or contra-indications to basic analgesics 1.
- Non-pharmacological approaches, including early mobilization, proper positioning, cold therapy, and relaxation techniques, should be used to complement medication management and minimize opioid use 1.
- Long-acting opioids should not be used routinely for acute postoperative pain, and patient-centred approaches should be used to limit the number of tablets and duration of usual discharge opioid prescriptions 1.
Medication Management
- Scheduled acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) and NSAIDs like ibuprofen (400-600mg every 6 hours) or ketorolac (15-30mg IV every 6 hours for no more than 5 days) should be used as baseline therapy 1.
- Opioids, such as morphine (5-10mg IV every 4 hours), hydromorphone (1-2mg IV every 4 hours), or oxycodone (5-10mg orally every 4-6 hours), should be used as rescue analgesics only when necessary, and with caution to minimize the risk of opioid-related harm 1.
Non-Pharmacological Approaches
- Early mobilization, proper positioning, cold therapy, and relaxation techniques should be used to complement medication management and minimize opioid use 1.
- Patient education on the use of non-pharmacological and non-opioid analgesia should be provided to reduce the amount and duration of opioids required to restore function 1.
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.
For pain management in post-operative patients, the dosage of oxycodone should be initiated at a range of 5 to 15 mg every 4 to 6 hours as needed for pain. It is essential to monitor patients closely for respiratory depression and adjust the dosage accordingly. The dosage should be individualized based on the patient's severity of pain, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse 2.
- Key considerations for pain management in post-operative patients include:
- Initiating treatment with the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
- Monitoring patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases.
- Adjusting the dosage based on the patient's response to the initial dose and their individual needs.
From the Research
Postoperative Pain Management
- Postoperative pain is typically treated with multimodal analgesia, using systemic acetaminophen and/or nonsteroidal anti-inflammatory drugs in conjunction with opioids as required 3.
- The use of an intravenous fixed-dose combination of acetaminophen and ibuprofen has been shown to be safe and well-tolerated for the treatment of postoperative pain 3, 4.
- NSAIDs are safe and effective in the treatment of postoperative pain, and they should be administered to all postoperative surgical patients unless contraindicated 5.
- Oxycodone combinations, such as with acetaminophen or nonsteroidal anti-inflammatory drugs, may offer certain advantages in terms of pain relief and reduced adverse effects 6.
Multimodal Pain Management
- Multimodal regimens are recommended for postoperative pain management, as they can provide more effective pain relief and reduce the risk of adverse effects 7.
- The exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure involved 7.
- A plan of care tailored to the individual and the surgical procedure involved is essential for safe and effective postoperative pain management 7.
Safety and Efficacy
- The safety profile of an intravenous fixed-dose combination of acetaminophen and ibuprofen has been shown to be comparable to previous studies, with no novel safety concerns 3.
- The use of NSAIDs in the treatment of postoperative pain has been shown to increase patient satisfaction and decrease opioid requirements, minimizing opiate-induced adverse events 5.
- However, NSAIDs and COX-2 inhibitors should be used with caution in colorectal surgery, as they may increase the risk of anastomotic leak 5.