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*While the type of opioid and amount should be individualized to each patient factoring the extent of surgery, patient goals, and clinician recommendation, the pills listed are presented as oxycodone 5mg pill equivalent.

**Oxycodone 5 mg tablet by mouth every 6 to 8 hours for the first 2 days as needed for pain, and then if severe pain persists then may continue taking one tablet every 12 hours for an additional few days.

Download a PDF of these guidelines here

To download our full Post-Surgical Opioid Prescribing Guidelines with clinician guidance on pre-op, intra-op, and post-op prescribing recommendations please click here

Please Note

All medications require a thorough evaluation for contraindications. Doses given are recommendations. Adjustments may be required for individual patients. In case of patient allergy to Oxycodone, replace 5mg Oxycodone with 2 mg Hydromorphone (Dilaudid).

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Some examples of relative contraindications:

  1. Gabapentin: renal dosing in chronic kidney disease

  2. Acetaminophen : contraindicated with liver disease or elevated LFTs

  3. NSAIDS: contraindicated with bleeding risks, GI ulcers and chronic kidney disease

  4. Tramadol: contraindicated with patient on SSRI and those with history of seizure

COX-2 Selective Inhibitor, Celecoxib

Give to postop patients who are unable to receive ketorolac because they have a history of GI ulcers or bleeding. Also give preop to orthopedic patients who do not have any contraindications.

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Dosing: Give 200 mg 1-2 hours before surgery and every 12 hours for 5 days. Decrease daily dose by 50% in patients with hepatic impairment (Child-Pugh Class B).

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OUR EXPERT PANEL

Marty Makary, MD, MPH, Surgeon Lead

Marie Hanna, MD, MBBCh, Pain Management Lead

Christian Jones, MD, MS, Gen. Surgery

Lisa Kodadek, MD, Gen. Surgery

James Taylor, MD, MPH, Gen. Surgery

Heidi Overton, MD, Gen. Surgery

Zachary Enumah, MD, Gen. Surgery

Christi Walsh, CRNP, Gen. Surgery

Mehran Habibi, MD, MBA, Breast Surgery

Kayode Williams, MD, MBA, Anesthesiology

Jon Russell, MD, ENT

Mark Bicket, MD, Anesthesiology

Joanna Etra, MD, Gen. Surgery

Stephen Broderick, MD, Thoracic Surgery

Tiffany Zavadsky, RN, Patient Representative

Brian Matlaga, MD, MPH, Urology

Clark Johnson, MD, MPH, Ob/Gyn 

Jeanne Sheffield, MD, Ob/Gyn

Ronen Shechter, MD, Anesthesiology

Hien Nguyen, MD, Hernia Surgery

Greg Osgood, MD, Orthopaedic Surgery

Richard Burkhart, MD, Gen. Surgery

Alex Blair, MD, Gen. Surgery

Wes Ludwig, MD, Urology

Suzanne Nesbit, PharmD

Matthew Pickering, PharmD

Susan Hutfless, PhD, MS, Research Team

Peiqi Wang, MD, MPH, Research Team

William Bruhn, Research Team

Suzette Morgan, Patient Representative

References

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  2. Bjorkman R, Hallman KM, Hedner J, Hedner T, Henning M. Acetaminophen blocks spinal hyperalgesia induced by NMDA and substance P. Pain 1994; 57: 259-64.

  3. Smith HS. Potential analgesic mechanisms of acetaminophen. Pain Physician 2009; 12: 269-80.

  4. Aronoff DM, Oates JA, Boutaud O. New insights into the mechanism of action of acetaminophen: Its clinical pharmacologic characteristics reflect its inhibition of the two prostaglandin H2 synthases. Clin Pharmacol Ther 2006; 79: 9-19.

  5. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology 2005; 102: 822-31.

  6. Maund E, McDaid C, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. Br J Anaesth 2011; 106: 292-7.

  7. Wininger SJ, Miller H, Minkowitz HS, Royal MA, Ang RY, Breitmeyer JB, Singla NK. A randomized, double-blind, placebo-controlled, multicenter, repeat-dose study of two intravenous acetaminophen dosing regimens for the treatment of pain after abdominal laparoscopic surgery. Clin Ther 2010; 32: 2348-69.

  8. De Oliveira GS, Jr., Agarwal D, Benzon HT. Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials. Anesth Analg 2012; 114: 424-33.

  9. Lowder JL, Shackelford DP, Holbert D, Beste TM. A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. Am J Obstet Gynecol 2003; 189: 1559-62.

  10. Tarkkila P, Saarnivaara L. Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults? Br J Anaesth 1999; 82: 56-60.

  11. Fletcher D, Zetlaoui P, Monin S, Bombart M, Samii K. Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery. Pain 1995; 61: 291-7.

  12. Gabbott DA, Cohen AM, Mayor AH, Niemiro LA, Thomas TA. The influence of timing of ketorolac administration on post-operative analgesic requirements following total abdominal hysterectomy. Eur J Anaesthesiol 1997; 14: 610-5.

  13. Chin CJ, Franklin JH, Turner B, Sowerby L, Fung K, Yoo JH. Ketorolac in thyroid surgery: quantifying the risk of hematoma. J Otolaryngol Head Neck Surg 2011; 40: 196-9.

  14. Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan FK, Furberg CD, Johnson DA, Mahaffey KW, Quigley EM, Harrington RA, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2008; 52: 1502-17.

  15. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005; 101: S5-22.

  16. Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology 2002; 97: 560-4.

  17. Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q. The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 2002; 95: 985-91, table.

  18. Menigaux C, Adam F, Guignard B, Sessler DI, Chauvin M. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg 2005; 100: 1394-9, table.

  19. Rorarius MG, Mennander S, Suominen P, Rintala S, Puura A, Pirhonen R, Salmelin R, Haanpaa M, Kujansuu E, Yli-Hankala A. Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain 2004; 110: 175-81.

  20. Turan A, Kaya G, Karamanlioglu B, Pamukcu Z, Apfel CC. Effect of oral gabapentin on postoperative epidural analgesia. Br J Anaesth 2006; 96: 242-6.

  21. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain--a systematic review of randomized controlled trials. Pain 2006; 126: 91-101.

  22. McNicol ED, Ferguson MC, Haroutounian S, Carr DB, Schumann R. Single dose intravenous paracetamol or intravenous propacetamol for postoperative pain. Cochrane Database Syst Rev. 2016 May 23;(5):CD007126. PMID: 27213715.

  23. Doleman B, Read D, Lund JN, Williams JP. Preventive Acetaminophen Reduces Postoperative Opioid Consumption, Vomiting, and Pain Scores After Surgery: Systematic Review and Meta-Analysis. Reg Anesth Pain Med. 2015 Nov-Dec;40(6):706-12. PMID: 26469366.

  24. Arumugam S, Lau CS, Chamberlain RS. Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis. J Pain Res. 2016 Sep 12;9:631-40. PMID: 27672340.

  25. Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia. 2015 Oct;70(10):1186-204. PMID: 26300519.

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