Acute Pain¶

Camille Adajar and Frances Alexandra Brown

Multimodal pain regimen suggestions¶

Tylenol
- Dose: 1,000mg PO Q8H (can reduce to 650 based on age or comorbidities)
- Indications: Analgesic and antipyretic
- Contraindications: Cirrhosis -- limit to 2000mg daily
Gabapentin
- Dose: 300mg PO Q8H (reduce to 100mg, Q12H dosing, or hold based on renal function, age, or sedation level)
- Indications: Neuropathic pain
- Contraindications: decreased CrCl
- Side effects: sedation, respiratory depression
Robaxin
- Dose: 500mg PO Q8H
- Indication: muscle relaxant
- Contraindication: IV formulation has preservative that is nephrotoxic
NSAIDs (check for adequate renal function and GI contraindications)
- Toradol 15-30mg IV Q6H x 5 days
- Ibuprofen 600mg Q6H
- Indications: analgesic, anti-inflammatory, antipyretic
- Contraindications: CKD/AKI, ulcers, GI bleed

Thoracic epidural catheter (TEC) - These are done and managed by the Acute Pain Service. With any issues or concerns, APS needs to be contacted.
- Indications: pain relief in thoracic dermatome distributions (rib fractures, BOLTs, etc.)
- Contraindications
  - Low platelets/INR > 1.5/coagulopathy
  - Hypotension
  - Positive blood cultures, fever, white count, etc.
TECs stay in 5-7 days, risk of infection increases beyond that point.
TECs run an infusion of Ropivacaine and Hydromorphone in the epidural space
Do NOT need to d/c anticoagulation to pull TEC
- Pt can only be on 5000 units of Subq heparin
- Pain service can pull TEC 4hrs after last SQH dose
- They cannot be on the weight adjusted 7500 units
- No Lovenox/Enoxaparin while TEC in place