Ofirmev in L&D

[turnupthevapor]

If anyone has been using I would appreciate a little insight:

Seems like the PI isn't too helpful. An associate said her post op cesarean was painless with the stuff. Certainly PO Tylenol is not that effective. Is this more effective than PO Tylenol? Thought on lactation and can it be used combined with toradol ? If the gut works use it? Toradol better?

Thanks

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[dhb]

If anyone has been using I would appreciate a little insight:

View attachment 177540

Seems like the PI isn't too helpful. An associate said her post op cesarean was painless with the stuff. Certainly PO Tylenol is not that effective. Is this more effective than PO Tylenol? Thought on lactation and can it be used combined with toradol ? If the gut works use it? Toradol better?

Thanks

I won't say that a post op cesarean will be pain free with iv paracetamol, it might be a little more effective than po. No problem with lactation, why wouldn't you combine it with toradol?

 

[bigdan]

The "more effective" part is likely what you would expect from IV vs PO admin....no 1st pass, faster plasma peak, etc. I like the stuff.

 

[lane]

Why use an IV drug when a patient can tolerate PO meds for a fraction of the cost? Is the benefit that significant to justify the cost?

 

[pgg]

An associate said her post op cesarean was painless with the stuff.

What does that mean? She got IV acetaminophen in addition to a bupivacaine spinal with intrathecal fentanyl and morphine plus scheduled ketorolac and some PRN PO opiate but the Ofirmev(tm) made recovery painless?

I think giving IV acetaminophen to a routine c-section patient who can take PO meds is silly and I wouldn't do it.


What I do for routine c-sections is intrathecal morphine, scheduled IV ketorolac x24h, scheduled PO acetaminophen, and PO MSIR PRN (in light of AAP's recs to not give oxycodone or hydrocodone to nursing mothers).

 

[PonyUp]

I'm a believer. Studied post-op pain and opioid requirements with/without ofirmev and I could tell who the placebo patients were, both coming out of the OR and over the next 24h. q1h neurochecks with these patients so the opioid burden made a significant difference.

No idea how much better it works in your L&D scenario though. Significantly different amount of pain with what I studied, and the cost isnt negligible.

 

[dhb]

Why use an IV drug when a patient can tolerate PO meds for a fraction of the cost? Is the benefit that significant to justify the cost?

No

 

[sevoflurane]

What's the deal with IV tylenol and activation of Cannabinoid/CB-1 receptors? Is it possible that these patients may be getting slightly euphoric via that pathway and hence potentiation of analgesia?

 

[sevoflurane]

http://www.ncbi.nlm.nih.gov/pubmed/17227290

"Although paracetamol has been used clinically for more than a century, its mode of action has been a mystery until about one year ago, when two independent groups (Zygmunt and colleagues and Bertolini and colleagues) produced experimental data unequivocally demonstrating that the analgesic effect of paracetamol is due to the indirect activation of cannabinoid CB(1) receptors."

 

[Dwindlin]

Was that affect only with IV admin?


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[sevoflurane]

I'm not sure about your question, but it stands to reason that if you are avoiding first pass metabolism, the effect on it's receptors may be enhanced.