Pre-op tylenol

[Maverikk]

how many people do this? My shop has IV tylenol but the benefits vs PO are underwhelming. Im thinking of starting to give most everyone who doesnt have an exception PO tylenol. Whats the downside?

Edit: what made me think of this is our spine cocktail which doesnt contain tylenol. I would think most GA cases would benefit

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[fakin' the funk]

Some docs at my place do po tylenol, based on what your mentioned. Most IV

 

[Noyac]

We have switched to P.O. Tylenol in the preop setting almost exclusively. The occasional case that lasts l8nger than 6 hrs might get IV DOSING.

 

[DM27]

I have been giving 1000mg vs 1300mg (depends if facility has the 500mg or 650mg preparation) when weight appropriate pre-op for a number of years and have noted good results post-operatively in terms of relative pain control. If you peruse the literature there is not an abundance of evidence that IV Acetaminophen has a significant benefit over pre-op oral acetaminophen in patients who can take it. Also, I am not sure where you work but our oral acetaminophen costs close to $0.01-0.05 compared to our IV acetaminophen which sits around $15-35. So it is a fairly significant % difference in cost.

 

[jwk]

We give IV tylenol routinely. Our biggest issue with PO meds (any of them) is that our pre-op nurses tend to give them just before our hand-off going to the OR.

 

[deleted59964]

Whats the downside?

Downside is kids that need a premed, take the panadol and then won’t take another oral premed.

Adults - none I can see

 

[DocVapor]

1,000 mg PO, +/- 300 Gabapentin PO, +/- Celebrex PO depending on case, patient factors, and if surgeon likes Toradol.

In Epic I have a dotphrase to make it easy to put in the instructions that they should get them with a sip of water on admission to pre-op if outpt / morning of surgery if inpt. No downside that I've seen in my extensive 2 yrs of residency (lol).

The kids you can do PR Tylenol after asleep before drapes go up if need be.

 

[WholeLottaGame7]

Downside is kids that need a premed, take the panadol and then won’t take another oral premed.

Adults - none I can see

Yeah dude, you mix the Tylenol and the midaz. Midaz tastes like s***t, tylenol is yummy and most of them have had it before. Makes it go down easier.

 

[abolt18]

1,000 mg PO, +/- 300 Gabapentin PO, +/- Celebrex PO depending on case, patient factors, and if surgeon likes Toradol.

In Epic I have a dotphrase to make it easy to put in the instructions that they should get them with a sip of water on admission to pre-op if outpt / morning of surgery if inpt. No downside that I've seen in my extensive 2 yrs of residency (lol).

The kids you can do PR Tylenol after asleep before drapes go up if need be.

Also been doing a lot of the APAP +/- gabapentin PO pre-op. Often don't do it before laparoscopic cases because, as mentioned above, the pre-op nurses often don't give it until right when we're about to go back, and I'm going to be putting down an OG in the next fifteen minutes so it seems wasted.

 

[Temeraire]

the pre-op nurses often don't give it until right when we're about to go back, and I'm going to be putting down an OG in the next fifteen minutes so it seems wasted.

Yup, I have definitely pulled out a partially-dissolved tablet of Tylenol stuck to the end of the OGT.

 

[Psai]

Yup, I have definitely pulled out a partially-dissolved tablet of Tylenol stuck to the end of the OGT.

Good thing I ate already

 

[deleted59964]

Yeah dude, you mix the Tylenol and the midaz. Midaz tastes like s***t, tylenol is yummy and most of them have had it before. Makes it go down easier.

what is this fancy Tylenol you have ... we have generics that taste like ****e, so we mix with cordial.

 

[Psai]

what is this fancy Tylenol you have ... we have generics that taste like ****e, so we mix with cordial.

It all tastes the same when it's in the butt

 

[propadope]

It all tastes the same when it's in the butt

Thats what ___ said

 

[DrAmir0078]

This is somehow a new experience for me !
Well, in our hospital in Iraq (if you like to get my knowledge shared), some surgeons (brilliants only), advise for the use of Tylenol (Or here called Paracetamol) perioperatively, as we have 1000 mg infusion IV container of it (mostly brought by the patients - lol, unfortunately hospital has shortage of medicines) !
Pre-Operative Paracetamol, the question is When: 30 min, 15 min prior to induction if GA?
Again, how about giving it 15 minutes prior to the end of Operation, what is the difference ! Any article to read !
Thanks !

 

[psychbender]

This is somehow a new experience for me !
Well, in our hospital in Iraq (if you like to get my knowledge shared), some surgeons (brilliants only), advise for the use of Tylenol (Or here called Paracetamol) perioperatively, as we have 1000 mg infusion IV container of it (mostly brought by the patients - lol, unfortunately hospital has shortage of medicines) !
Pre-Operative Paracetamol, the question is When: 30 min, 15 min prior to induction if GA?
Again, how about giving it 15 minutes prior to the end of Operation, what is the difference ! Any article to read !
Thanks !

If you give it before it at the start of surgery, I've noticed a decrease in intraoperative opiate requirement, with pts more awake in PACU. The downside is that, for longer cases, the additional analgesic effect may not last as long post-op. The simple solution to that is to give another dose of oral acetaminophen when able.

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[DrAmir0078]

If you give it before it at the start of surgery, I've noticed a decrease in intraoperative opiate requirement, with pts more awake in PACU. The downside is that, for longer cases, the additional analgesic effect may not last as long post-op. The simple solution to that is to give another dose of oral acetaminophen when able.

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Thanks a lot
Cool, next time I will give it a try !
The interesting thing is that opiate over here, we are currently have is Fentanyl, I do it prior to the induction; sometimes and honestly we used it perioperatively when we think there is an awareness (although we give additional muscle relaxants), unknown tachycardia (the patient is not awake, but tachycardic).
In addition, the last week, I had this try especially after long surgeries like Thyriodectomies, I had two emergence delirium and have to give a combo of midozolam 1mg - 1.5 mg IV , plus another 25 mg Fentanyl IV, and although both cases were covered with Tylenol or acetaminophen infusion perioperatively and a new medicine which is called acupan... The patient response is terrific!
Just sharing my experience!

@DrAmir0078

 

[BeddingfieldMD]

I give preop Tylenol and zofran fairly routinely these days.


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[MetaPhysicianBlog]

It all tastes the same when it's in the butt

Any RCTs supporting this notion? I kid I kid.

 

[Urzuz]

I give preop Tylenol and zofran fairly routinely these days.


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There is a fair amount of evidence showing that ondansetron is more effective if administered at the end of the procedure (i.e.: 30 min before the conclusion of anesthesia). So unless the cases you are doing are extremely short, you may not be getting as much bang for your buck. Just something to consider.

 

[Noyac]

There is a fair amount of evidence showing that ondansetron is more effective if administered at the end of the procedure (i.e.: 30 min before the conclusion of anesthesia). So unless the cases you are doing are extremely short, you may not be getting as much bang for your buck. Just something to consider.

That’s my understanding as well. But does the PO zofran perform differently?

 

[Urzuz]

That’s my understanding as well. But does the PO zofran perform differently?

Not sure, all the studies I found only compare the timings of IV administration. It didn't even register in my head that he may be giving it orally.

While we're on the subject, is there a significant cost differential between IV and PO ondansetron?

 

[deleted162650]

Not sure, all the studies I found only compare the timings of IV administration. It didn't even register in my head that he may be giving it orally.

While we're on the subject, is there a significant cost differential between IV and PO ondansetron?

The ODTs are much pricier than IV.

I think I set of ODTs is pretty close to IV.

 

[abolt18]

Not sure, all the studies I found only compare the timings of IV administration. It didn't even register in my head that he may be giving it orally.

While we're on the subject, is there a significant cost differential between IV and PO ondansetron?

We've been doing PO or ODT at my hospital just because we've had IV zofran on very short supply for like 6 months. Only just lately their supply is increased and it'll be in our carts again.

 

[dchz]

There is a fair amount of evidence showing that ondansetron is more effective if administered at the end of the procedure (i.e.: 30 min before the conclusion of anesthesia). So unless the cases you are doing are extremely short, you may not be getting as much bang for your buck. Just something to consider.

please present the evidence.

 

[nimbus]

There is a fair amount of evidence showing that ondansetron is more effective if administered at the end of the procedure (i.e.: 30 min before the conclusion of anesthesia). So unless the cases you are doing are extremely short, you may not be getting as much bang for your buck. Just something to consider.

please present the evidence.

Zofran half life is around 4 hours so it probably depends on the duration of the procedure.