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Intravenous Acetaminophen


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We have this on our hospital formulary; it is restricted to PACU right now.

I am writing a request for expanding use to postop analgesia in ICU.

 

I saw a few mentions of it in the ketorolac thread...who is using it?

ER folks?

Inpatient PAs?

Mike Jones (you are a specialty unto yourself here, sir.....)

 

I am interested in hearing your experiences.

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I use it on almost all of my post-op thoracotomy patients. I do check a CMP on all pre-op labs, and obviously not give if even a whiff of liver issues pop up. I typically give Acetaminophen 1grm IV Q6 hrs x 6 doses. With a follow-up order for no oral sources of acetaminophen for 36 hours.

 

I have had pretty good results, only once have I dc'd it due to liver enzyme elevations.

 

I should note we also use OnQ pain caths, and usually a spinal narc- if not an infected pleural space.

 

Had brief interaction with one of the reps about 3 wks ago, had some information and study data....nothing that was really that interesting.

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We have this on our hospital formulary; it is restricted to PACU right now.

I am writing a request for expanding use to postop analgesia in ICU.

 

I saw a few mentions of it in the ketorolac thread...who is using it?

ER folks?

Inpatient PAs?

Mike Jones (you are a specialty unto yourself here, sir.....)

I am interested in hearing your experiences.

We use it in the ICUs. In our hospital it's restricted to ICU and pain medicine. Seems to work pretty well. I usually give q8hr x 3. We have also been going away from APAP in other formulations.

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Haven't used it but we've been using IV Ibuprofen frequently postop due to the toradol shortage. Works quite well for patients who prefer not to use or do not require opioids and are still npo. The surgeons are even ok with recent GI surgery. I guess the IV formulation has far less risk of GI bleed than the oral form.

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  • 2 years later...

I used it for post-op Neurosurgery, mostly spine cases.

It was one NSx's preference.

1g IV q8h for 3 days.

Of course, I couldn't use Norco/Vic/Percs at the same time.

We'd use either PCA or oral morphine elixir and then add up the morphine equivalent dosing over 24hrs and then convert to PO meds.

 

The other NSx I worked with didn't use IV acetaminophen and would just do PCA and then transition to Percocet or Norco., which was simpler.

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  • 3 years later...
  • Moderator
On ‎7‎/‎5‎/‎2012 at 0:49 PM, EMEDPA said:

never used it. would love to give it to a drug seeker who refuses to leave without a shot.

them: I demand a shot

me: ok

them(20 min later) what was that?

me: 500 dollar tylenol. have a nice day(hands d/c paperwork)

THIS IS HOW I USE IT

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On 7/5/2012 at 2:49 PM, EMEDPA said:

never used it. would love to give it to a drug seeker who refuses to leave without a shot.

them: I demand a shot

me: ok

them(20 min later) what was that?

me: 500 dollar tylenol. have a nice day(hands d/c paperwork)

I about snorted morning coffee reading this because I immediately thought the same thing.  I try so hard not to be cynical and you guys can't even let me get out the door this morning without a high five.

All this being said, I wonder if the bioavailability is greater, faster, than it would be if able to give po?  Comparison would be glucocorticoids.  What about just sticking a suppository up the rear torpedo tube if they're not taking p.o.?  BTW, what's the cost if anyone should know?

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Solution (Ofirmev Intravenous)  10 mg/mL (100 mL): $45.02

Tablets (Acetaminophen Oral) 325 mg (100): $1.86 / 500 mg (100): $2.61 (among much variation)

Bio-availability is surely faster than PO and would bypass a first pass hepatic effect. Anecdotally, have heard it is "great" - restricted formulary to post-op only at my institution.

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