Ofirmev -- Good, Bad, or Indifferent??

[Fooper]

Our hospital/health system now has Ofirmev (IV acetaminophen). I'm interested in anyone's real world clinical experience with it, especially for post-op pain control, and how it compares to ketorolac. Use in outpatients? Seems like they use paracetamol in Europe quite a bit. Thanks!

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[Idiopathic]

im indifferent at this point but i would like to see some efficacy data. tylenol is a great drug but ive had tordol and i cant imagine tylenol touching the pain i had. obviously a little less risk however.

 

[IN2B8R]

Our hospital/health system now has Ofirmev (IV acetaminophen). I'm interested in anyone's real world clinical experience with it, especially for post-op pain control, and how it compares to ketorolac. Use in outpatients? Seems like they use paracetamol in Europe quite a bit. Thanks!

One gram IV q 6 hrs, as per the Sinatra study.... Works well for mild-moderate pain, especially when used as part of multi-modal analgesia cocktail with NSAIDs, gabapentins, LA's, etc.... Run the 100mL bottle over 15 minutes, as per the recommendations (they supposedly ran their studies that way, i.e., did not just slam the entire 100 mL's in....), but I doubt that anything will go wrong if you ran it a little faster.... Works well with our total joints and general cases (choles, etc...). I obviously do not use it on patients with intrinsic liver disease or those with severe kidney disease. Must not exceed four grams per day. Still use 15mg/kg in peds, may (for normal, >2.5 y.o.) use a bigger loading dose of up to 40mg/kg. Beware if the surgeon has patient who is also on narcs/tylenol combos, i.e., Percocet and the like: liver failure is no joke

 

[G0S2]

I'm personally looking forward to Caldolor and want to see some comparison with Toradol.

 

[gtb]

I'm using it for post-op pain after craniotomy procedures. I give 1 gram when the surgeons start closing the dura. Intraoperative opioids are somewhere around 1.5 - 2.0 mcg/kg for induction & pinning, then a remifentanyl infusion until pins are out. Propofol gtt or sevo depending on MEP monitoring. Nearly every patient is extubated awake in the OR.

Anecdotally, I believe that I'm using less fentanyl before going to PACU, and the nurses are saying that pain control seems improved with less opioid. Informally collecting data, but no conclusions yet. Since nausea & vomiting occur in > 50% of craniotomy procedures (closer to 100% of acoustic neuromas & transsphenoidals), I'm looking for ways to minimize the risk of vomiting. We don't give Toradol for these procedures.

While pain control seems improved, no change in the incidence of N/V has been noticed by our PACU team. That mimics published studies for orthopedic procedures. Overall less opioids, improved pain control, but no reduction in N/V. Cadence has contributed funding for most of the published studies.

http://www.ncbi.nlm.nih.gov/pubmed/18843665 (2008 Cochrane review)
http://www.ncbi.nlm.nih.gov/pubmed/21114616 (Recent literature review)

 

[sevo85288]

I share your opinion below. It is leading me to use less opioids. I find it reduces opioids intake. May be by 10-30%. It is being used by our cardiac surgeons in the ICU for post CABG pts. They believe it is improving pain control and leading to more awake and cooperative pts.

I'm using it for post-op pain after craniotomy procedures. I give 1 gram when the surgeons start closing the dura. Intraoperative opioids are somewhere around 1.5 - 2.0 mcg/kg for induction & pinning, then a remifentanyl infusion until pins are out. Propofol gtt or sevo depending on MEP monitoring. Nearly every patient is extubated awake in the OR.

Anecdotally, I believe that I'm using less fentanyl before going to PACU, and the nurses are saying that pain control seems improved with less opioid. Informally collecting data, but no conclusions yet. Since nausea & vomiting occur in > 50% of craniotomy procedures (closer to 100% of acoustic neuromas & transsphenoidals), I'm looking for ways to minimize the risk of vomiting. We don't give Toradol for these procedures.

While pain control seems improved, no change in the incidence of N/V has been noticed by our PACU team. That mimics published studies for orthopedic procedures. Overall less opioids, improved pain control, but no reduction in N/V. Cadence has contributed funding for most of the published studies.

http://www.ncbi.nlm.nih.gov/pubmed/18843665 (2008 Cochrane review)
http://www.ncbi.nlm.nih.gov/pubmed/21114616 (Recent literature review)