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P A I N
M A N A G E M E N T
NSAIDs rank at the top of the scale for achieving at least 50% of maximum pain relief, while codeine sits at the bottom.
• Acetaminophen. This is one of the safest drugs we have (even in
patients with hepatic issues), not to mention amazingly potent, with
one of the broadest activities of any analgesic. No one's entirely sure
precisely how acetaminophen works, but it's effective in neurological
and nociceptive pain. A maximum dose of 4g a day is well-tolerated,
although the FDA recommends 3g per day over the counter, just to be
on the safe side. Giving 1g pre-operatively helps to get ahead of the
pain. Post-op IV acetaminophen, which provides more rapid absorption in the central compartment, delayed the need for an opioid dose
by 3 hours in 1 study. Further, the efficacy of Percocet has been
shown to be similar to the efficacy of acetaminophen, without the
oxycodone. OSM
Dr. Viscusi (eugene.viscusi@jefferson.edu) is director of acute pain management and associate professor of anesthesiology in the department of anesthesiology at Thomas Jefferson University in Philadelphia, Pa.
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