IV tylenol

[crna2006]

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Well it is happening again. IV Tylenol must have some subliminal advertising or something. Every few years PACU nurses will go nuts for this stuff and act like it is the holy grail/magic potion that cures all post op pain. They will then start complaining and insist it be used in EVERY case. They will say " a study shows" and not be able to trot it out, and finally "every one does it why won't you".
It is expensive and not particularly effective is the response which is met with cold hostility and blind opposition. I swear so tired of this pattern

 

[dannyboy1]

Well it is happening again. IV Tylenol must have some subliminal advertising or something. Every few years PACU nurses will go nuts for this stuff and act like it is the holy grail/magic potion that cures all post op pain. They will then start complaining and insist it be used in EVERY case. They will say " a study shows" and not be able to trot it out, and finally "every one does it why won't you".
It is expensive and not particularly effective is the response which is met with cold hostility and blind opposition. I swear so tired of this pattern

Unless you are paying for it why do you even care….

 

[UscGhost]

Well it is happening again. IV Tylenol must have some subliminal advertising or something. Every few years PACU nurses will go nuts for this stuff and act like it is the holy grail/magic potion that cures all post op pain. They will then start complaining and insist it be used in EVERY case. They will say " a study shows" and not be able to trot it out, and finally "every one does it why won't you".
It is expensive and not particularly effective is the response which is met with cold hostility and blind opposition. I swear so tired of this pattern

It's only a few $ for us so we use it. If it makes pacu nurses feel better and call me less, worth it

 

[cchoukal]

Usually pharmacy is whispering in your other ear to limit its use due to cost…

 

[Bryan O’Blivion]

I like it in PACU because it provides rapid onset analgesia without inducing nausea or somnolence. It’s psychologically helpful to inject medication for pain control when someone asks for it. Same with ketorolac. Worth the money to move people out of PACU.

 

[crna2006]

It just seems amazing to me the same thing happening again and again, I wonder if the tylenol people are paying PACU nurses.
The repeated blind belief is just incredible.

 

[UscGhost]

It just seems amazing to me the same thing happening again and again, I wonder if the tylenol people are paying PACU nurses.
The repeated blind belief is just incredible.

Well I look at it as a useful option.

Patient with a 4-5 pain level wants something. Nurse wants to give something. If they give opioids, then patient gets nauseous.

Helps with pain a little. I take Tylenol at home and it helps

 

[abolt18]

We have the generic stuff so we get zero pushback from pharmacy. I use it fairly often, but still probably <50% of my cases.

 

[Beeftenderloin]

We’re pushed pretty hard by admin to provide multi-modal adjuncts whenever possible at my shop. We have generic IV acetaminophen stocked in our med trays and are encouraged to use it liberally. Our OR satellite pharmacy even has a little basket of it sitting right by the door so we can just grab it as we’re walking past. The biggest barrier to use is the fact that I have to spike it and piggyback it onto the IV as opposed to something like ketorolac that I can just quickly draw up and give.

 

[aneftp]

Iv Tylenol is like adductor canal blocks without surgeon blocking posterior side for pain control.

 

[Maverikk]

Why not just give it PO for all suitable patients in pre-op? One place I did totals had everyone got PO tylenol and TXA on their protocol

 

[ToKingdomCome]

Iv Tylenol is like adductor canal blocks without surgeon blocking posterior side for pain control.

Should be doing an IPACK then

 

[GassYous]

I just read an article that said if you give zofran then iv tylenol has zero effect. Since basically everyone gets zofran why throw away the money?

 

[Airway]

I just read an article that said if you give zofran then iv tylenol has zero effect. Since basically everyone gets zofran why throw away the money?

Link please

 

[nimbus]

Link please

Analgesic interaction between ondansetron and acetaminophen after tonsillectomy in children: the Paratron randomized, controlled trial - PubMed

An interaction between acetaminophen and ondansetron is suggested, with children receiving three times more morphine during pain titration in the recovery room. More studies are necessary to evaluate whether this finding is clinically relevant enough to preclude the simultaneous perioperative...

pubmed.ncbi.nlm.nih.gov

https://www.sciencedirect.com/science/article/abs/pii/S0952818017300764

 

[DrOwnage]

It just seems amazing to me the same thing happening again and again, I wonder if the tylenol people are paying PACU nurses.
The repeated blind belief is just incredible.

There is data to show that it works, even for more painful procedures like hearts. There is a specific transporter that works to move acetaminophen across the BBB. It primarily works centrally, in the spinal cord (descending serotonergic tracts) and not peripherally. When you give it IV at the end of a case or in PACU it is 100% bioavailable immediately to be transported across the BBB vs. rectal and PO which take much longer to reach maximal central concentration. It does help, you just have to look at the pharmacokinetics.

Also I can’t even count how many times patients are given PO Tylenol 1 hour prior to their case for a 3 hour case. By the time they get to PACU it’s doing jack ****. Source: I’ve published literature on IV acetaminophen in pubmed/journal of cardiovascular and thoracic anesthesia.

 

[crna2006]

There is data to show that it works, even for more painful procedures like hearts. There is a specific transporter that works to move acetaminophen across the BBB. It primarily works centrally, in the spinal cord (descending serotonergic tracts) and not peripherally. When you give it IV at the end of a case or in PACU it is 100% bioavailable immediately to be transported across the BBB vs. rectal and PO which take much longer to reach maximal central concentration. It does help, you just have to look at the pharmacokinetics.

Also I can’t even count how many times patients are given PO Tylenol 1 hour prior to their case for a 3 hour case. By the time they get to PACU it’s doing jack ****. Source: I’ve published literature on IV acetaminophen in pubmed/journal of cardiovascular and thoracic anesthesia.

I have no doubts that it helps, the issue is the childlike belief in this drug by staff, and their aggressive efforts to MAKE anesthesia administer it regardless of circumstances.

 

[JoelJoel84]

I have no doubts that it helps, the issue is the childlike belief in this drug by staff, and their aggressive efforts to MAKE anesthesia administer it regardless of circumstances.

Are you even a physician?

I’ll go with the evidence- based medicine , which correlates with the positive clinical effects I’ve seen for years now.

 

[NicholasPavona]

Well it is happening again. IV Tylenol must have some subliminal advertising or something. Every few years PACU nurses will go nuts for this stuff and act like it is the holy grail/magic potion that cures all post op pain. They will then start complaining and insist it be used in EVERY case. They will say " a study shows" and not be able to trot it out, and finally "every one does it why won't you".
It is expensive and not particularly effective is the response which is met with cold hostility and blind opposition. I swear so tired of this pattern

Probably because you're an anesthesia nurse and they don't trust you.

 

[NicholasPavona]

Are you even a physician?

Absolutely not. Though this cohort does like to obfuscate the term "doctor" and refer to themselves in that manner often.

 

[crna2006]

Are you even a physician?

I’ll go with the evidence- based medicine , which correlates with the positive clinical effects I’ve seen for years now.

I am a crna who.is quoting multiple studies showing no appreciable difference between PO and iv tylenol and from years of clinical observation of no real difference.
If you have studies showing a real difference please let me know.

 

[psychbender]

Analgesic interaction between ondansetron and acetaminophen after tonsillectomy in children: the Paratron randomized, controlled trial - PubMed

An interaction between acetaminophen and ondansetron is suggested, with children receiving three times more morphine during pain titration in the recovery room. More studies are necessary to evaluate whether this finding is clinically relevant enough to preclude the simultaneous perioperative...

pubmed.ncbi.nlm.nih.gov

https://www.sciencedirect.com/science/article/abs/pii/S0952818017300764

Could it be that the patients in the droperidol arm were too sedated to ask for one very low dose of morphine in PACU? Reported pain scores were the same.

 

[psychbender]

There is data to show that it works, even for more painful procedures like hearts. There is a specific transporter that works to move acetaminophen across the BBB. It primarily works centrally, in the spinal cord (descending serotonergic tracts) and not peripherally. When you give it IV at the end of a case or in PACU it is 100% bioavailable immediately to be transported across the BBB vs. rectal and PO which take much longer to reach maximal central concentration. It does help, you just have to look at the pharmacokinetics.

Also I can’t even count how many times patients are given PO Tylenol 1 hour prior to their case for a 3 hour case. By the time they get to PACU it’s doing jack ****. Source: I’ve published literature on IV acetaminophen in pubmed/journal of cardiovascular and thoracic anesthesia.

I don't doubt the mechanism for how IV acetaminophen could be superior to PO, but I don't think there is any good data to demonstrate actual clinical superiority of IV vs PO acetaminophen. This coming from a big acetaminophen believer that used IV acetaminophen for all once it came out.

I used to give it IV preop for all my cardiac cases, then the surgeons changed their order sets to include PO one hour before surgery. Intraop fentanyl requirements were the same, and there did not seem to be a difference in the unit (most got an IV redose right after we got upstairs, as the surgeons are slow). It's the same story for my total joints, VATS, major vascular, etc cases. Do you have new data showing meaningful clinical difference when compared to the same regimen PO?

 

[Maverikk]

There is data to show that it works, even for more painful procedures like hearts. There is a specific transporter that works to move acetaminophen across the BBB. It primarily works centrally, in the spinal cord (descending serotonergic tracts) and not peripherally. When you give it IV at the end of a case or in PACU it is 100% bioavailable immediately to be transported across the BBB vs. rectal and PO which take much longer to reach maximal central concentration. It does help, you just have to look at the pharmacokinetics.

Also I can’t even count how many times patients are given PO Tylenol 1 hour prior to their case for a 3 hour case. By the time they get to PACU it’s doing jack ****. Source: I’ve published literature on IV acetaminophen in pubmed/journal of cardiovascular and thoracic anesthesia.

This was the pharmacokinetic data presented by Cadence pharmaceuticals. It makes very little clinical sense and I know of no actual robust clinical evidence to support it, PACU nurse satisfaction of feeling having done something may not have been studied

 

[jwk]

I have no doubts that it helps, the issue is the childlike belief in this drug by staff, and their aggressive efforts to MAKE anesthesia administer it regardless of circumstances.

You don’t like it so it’s “childlike”?

 

[UscGhost]

I am a crna who.is quoting multiple studies showing no appreciable difference between PO and iv tylenol and from years of clinical observation of no real difference.
If you have studies showing a real difference please let me know.

Are you giving PO Tylenol and the nurses are complaining that you didn't give it IV?

 

[crna2006]

You don’t like it so it’s “childlike”?

No the insistence on its use, the belief that it fixes all the post op pain issues, despite the mountain of evidence that it does not this belief is childlike.

 

[crna2006]

Are you giving PO Tylenol and the nurses are complaining that you didn't give it IV?

I could and have given it PO, they did not do care. If it is IV then OMG you did not give it! You evil person. It works even though I don't have the data or clinical information it works!

 

[Bryan O’Blivion]

I have received IV acetaminophen as a patient, and my perception was that that I could feel pain relief before the infusion was finished. Anecdotally, it seems like some people respond to acetaminophen and some don’t really.

I never really noticed much impact on PACU from 975 mg PO pre op.

 

[Airway]

I just read an article that said if you give zofran then iv tylenol has zero effect. Since basically everyone gets zofran why throw away the money?

"However, the reduction was of marginal clinical importance and short-lived"

Anyways everyone gets iv Tylenol at my place. I had a resident give it for a shoulder with a function 0.5% isb (to be clear I disagreed with that decision).

 

[GassYous]

I have received IV acetaminophen as a patient, and my perception was that that I could feel pain relief before the infusion was finished. Anecdotally, it seems like some people respond to acetaminophen and some don’t really.

I never really noticed much impact on PACU from 975 mg PO pre op.

Well yeah I feel pain relief from swallowing some tylenol pills but I know it hasn't even gotten to my belly yet

 

[Bryan O’Blivion]

Well yeah I feel pain relief from swallowing some tylenol pills but I know it hasn't even gotten to my belly yet

I am a person who benefits from Tylenol, I get great pain relief from PO 650 mg. However, I can say from having a painful fracture, my experience was that the pain went from agonizing to tolerable before the 100 cc bag was empty. I’m pretty sure it wasn’t just psychological, but the rapid onset from the injection was satisfying. The zofran thing is interesting though.

 

[pgg]

No the insistence on its use, the belief that it fixes all the post op pain issues,

I find it hard to believe that anybody anywhere really thinks it fixes all post op pain, much less that there are enough such people around you that it's annoying. This sounds like hyperbole.

It helps with pain.

It's not an opioid.

It's not sedating.

Essentially nobody is allergic to it and it is safe in just about everybody.

It's probably somewhat more effective than PO preop acetaminophen. Whether the cost differential between PO and IV is worth it can be debated.

Most patients undergoing painful procedures should probably get it.


This is a very, very weird hill to die on.

despite the mountain of evidence that it does not this belief is childlike.

Can you show us on the doll where the Ofirmev(TM) rep touched you? 🙂

 

[crna2006]

I find it hard to believe that anybody anywhere really thinks it fixes all post op pain, much less that there are enough such people around you that it's annoying. This sounds like hyperbole.

It helps with pain.

It's not an opioid.

It's not sedating.

Essentially nobody is allergic to it and it is safe in just about everybody.

It's probably somewhat more effective than PO preop acetaminophen. Whether the cost differential between PO and IV is worth it can be debated.

Most patients undergoing painful procedures should probably get it.


This is a very, very weird hill to die on.



Can you show us on the doll where the Ofirmev(TM) rep touched you? 🙂

My wallet (isn't that where they all touch you)?😀

 

[pgg]

My wallet (isn't that where they all touch you)?😀

Reps don't take our money, they bring us lunch. Or at least they used to.

Now I have to hang out with the EP cardiologists to get free Panera or Chick Fil A. 🙂


Any time I start to worry about the cost of my anesthetic, I just think back to that one time I saw a surgeon drop a prosthetic hip on the floor. Or maybe that time someone forgot to keep track of expiration dates and they gave me a giant bag full of expired prosthetic heart valves to use as teaching props for the residents. I think I've got quite a few bottles of IV acetaminophen to go before I catch up. 🙂

The cost of what we do is literally lost in the noise of ten extra minutes in the OR because the RN and scrub tech got the lap count wrong and we have to get an X-ray.

 

[nimbus]

Reps don't take our money, they bring us lunch. Or at least they used to.

Now I have to hang out with the EP cardiologists to get free Panera or Chick Fil A. 🙂

Any idea why cardiology reps can still spoil us so much while all the other reps have dried up? Medtronic and Edwards are my favs 😋

 

[Teillard]

It just seems amazing to me the same thing happening again and again, I wonder if the tylenol people are paying PACU nurses.
The repeated blind belief is just incredible.

It's helpful...your response is disproportionate....

 

[coffeebythelake]

Should be doing an IPACK then

AC + iPACK, but they still hurt on the outer aspect of the knee

 

[coffeebythelake]

Well it is happening again. IV Tylenol must have some subliminal advertising or something. Every few years PACU nurses will go nuts for this stuff and act like it is the holy grail/magic potion that cures all post op pain. They will then start complaining and insist it be used in EVERY case. They will say " a study shows" and not be able to trot it out, and finally "every one does it why won't you".
It is expensive and not particularly effective is the response which is met with cold hostility and blind opposition. I swear so tired of this pattern

i agree with you
the benefit is minimal to modest at best if you don't plan to do multimodal analgesia (not just tylenol and opioids)

 

[Beeftenderloin]

Any idea why cardiology reps can still spoil us so much while all the other reps have dried up? Medtronic and Edwards are my favs 😋

For whatever reason, at least where I’m at, they’ve banned all meals, gifts, etc. from pharmaceutical reps, but still allow medical device reps to bring in food. I think it started when the opioid epidemic was heating up.

Food from Pfizer = compromising, unethical, evil

Food from Medtronic = yummy, nutritious, TAVRtastic!

 

[coffeebythelake]

For whatever reason, at least where I’m at, they’ve banned all meals, gifts, etc. from pharmaceutical reps, but still allow medical device reps to bring in food. I think it started when the opioid epidemic was heating up.

Food from Pfizer = compromising, unethical, evil

Food from Medtronic = yummy, nutritious, TAVRtastic!

Food from Pfizer = go to medicine folk
Food from Medtronic = go to surgeons and proceduralists

 

[Drwine]

For whatever reason, at least where I’m at, they’ve banned all meals, gifts, etc. from pharmaceutical reps, but still allow medical device reps to bring in food. I think it started when the opioid epidemic was heating up.

Food from Pfizer = compromising, unethical, evil

Food from Medtronic = yummy, nutritious, TAVRtastic!

One of the reasons I love doing structural heart cases. 😉 I was able to look up what was reported to CMS on their Open Payments database. On days we do 6-7 TAVRs I know the Medtronic or Edwards rep is the highest paid person for the day. The food is just a rounding error.

 

[ToKingdomCome]

One of the reasons I love doing structural heart cases. 😉 I was able to look up what was reported to CMS on their Open Payments database. On days we do 6-7 TAVRs I know the Medtronic or Edwards rep is the highest paid person for the day. The food is just a rounding error.

How much are they paid