Avoiding post-operative narcotics

Avoiding post-operative narcotics

Narcotics or opiate pain medications have a role in pain management after surgery, but I, like many others, would like to see that role diminish. Opiate pain medications are growing in scrutiny, and duly so due to an epidemic of narcotic addiction as well as side effects like nausea and constipation. 

These five little pills pictured can have a dramatic effect on your post operative pain. Surprisingly, patients always seem more hesitant to take acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) than narcotic pain medication. Most healthy individuals can take acetaminophen and NSAIDs with little risk of complication.  Individuals with liver disease or cirrhosis should limit their daily intake of acetaminophen to 3,000 mg per day. Normal individuals should take no more than 4,000 mg. Acetaminophen comes in different strengths including 325 mg, 500 mg, and 650 mg. Check your bottle and keep track of the amount and times on a sheet of paper. 

Ibuprofen typically comes in 200 mg.  Most everyone can take up to 1,200 mg per day with little risk. Most healthy individuals can take up 2,400 mg of ibuprofen per day, which is 12 pills, on a short term basis. People with certain condition should be more cautious taking NSAIDs. Those conditions include history of stomach ulcers, high blood pressure, bleeding problems, heart disease, kidney disease, age older than 60 or if taking a diuretic. You should also be careful combining NSAIDS with anticoagulants like warfarin, Eliquis, Plavix or aspirin. Examples of other NSAIDs, or non-steroidal anti inflammatory medications, are Aleve, Motrin, Advil, ibuprofen, and naproxen. 

Narcotics, acetaminophen and NSAIDs all have different mechanisms of action and can be safely taken together. Just be careful that your narcotic medication doesn’t already have acetaminophen or NSAIDs in it. Many times patients are prescribed medicines like Norco or Percocet which have acetaminophen in them. If your medicine has two names and two numbers like: 5/325, it’s likely it contains acetaminophen.  

Narcotics, acetaminophen and NSAIDs have a synergistic effect on each other, meaning that they make each other work better. For example, 2 + 2 = 5. Meaning that their combined effect is more than the sum of their individual effect. Even If I were undergoing surgery, I would take two 500 mg acetaminophen and three 200 mg ibuprofen every 6 hours. Save the narcotic medication for break through pain when this regimen doesn’t work.