post-Surgical Pain Management Strategies

Post-surgical pain can be managed using a variety of different medications.  Some individuals may need or want to use an opioid (e.g. Vicodin, Norco, Percocet, Tylenol with Codeine) to alleviate moderate to severe pain, while others may not.  Although it is best to avoid the usage of opioids in general because of the several risks involved, in some instances they may be necessary for pain relief.  Two strategies for pain management are outlined below, one without the use of opioids and one with the use of opioids.

Non-Opioid Medication Pain Management

Mild post-surgical pain

  • Use an Over-The-Counter (OTC) Non-steroidal anti-inflammatory drug (NSAID) alone.  Ibuprofen (Advil, Motrin) 200-400 mg (1-2 tablets) every 4-6 hours as needed or  naproxen (Aleve) 220 mg (1 tablet) every 8-12 hours as needed.
  • Use acetaminophen (Tylenol) 325-500 mg (1 tablet of either 325 mg or 500 mg) every 4-6 hours as needed.  The maximum dosage is 3250 mg/day for the 325 mg tablet and 3000 mg/day for the 500 mg tablet.

Moderate to severe post-surgical pain

  • Use of an OTC NSAID alone:

              1.  Ibuprofen (Advil, Motrin):  600 mg (3 tablets) every 4-6 hours as needed or 800 mg (4 tablets) every 6 hours.  The maximum dosage is     3200 mg/day.

             2.  Naproxen (Aleve):  440 mg (2 tablets) initially, then 220 mg (1 tablet) every 6-8 hours as needed. The maximum dose on day 1 is 1250     mg/day and each subsequent day is 1000 mg/day.

  • Use of an OTC NSAID plus acetaminophen.  Use either ibuprofen (Advil, Motrin) or naproxen (Aleve) dosed as outlined above (Use of an OTC NSAID alone) plus acetaminophen (Tylenol) 325 mg every 4-6 hours as needed.  As the pain decreases, either the ibuprofen or acetaminophen is stopped while maintaining the same dosing schedule for the other medication OR both medications are continued together used at longer time intervals (e.g. taken every 6-8 hours instead of every 4-6 hours).

Opioid Medication Pain Management (with the goal of adequately managing pain using the least amount of opioids possible)

  • Moderate to severe post-surgical pain

         1.  Use an opioid (Vicodin, Norco, Percocet) 1 tablet (as instructed) plus ibuprofen (Advil, Motrin) 200-400 mg (1-2 tablets) every 4-6 hours as   needed.

         2.  As the pain level decreases, you can lengthen the time between doses (e.g. every 6-8 hours), then stop using the opioid (Vicodin, Norco, Percocet) and continue using only ibuprofen (Advil, Motrin) or naproxyn (Aleve).  You can add acetaminophen (Tylenol) to the NSAID if necessary.  Follow the Non-Opioid moderate to severe post-surgical pain management instructions regarding tapering.

*Important Considerations*

  • You must not take any of these medications if you have any allergies or side effects to them.
  • You cannot take any NSAID like ibuprofen (Advil, Motrin) or naproxen (Aleve) if you are taking any blood thinner, including aspirin or have a medical condition that prevents you from using them (peptic ulcer, kidney disease etc.).
  • Acetaminophen (Tylenol) must not be taken with an opioid as most opioids contain acetaminophen and an overdose of acetaminophen could easily occur resulting in liver damage.