After surgery is planned: If no other physician prescribing pain medication
After surgery is complete: In all cases for a specific amount of time
Medications we generally use
For nociceptive pain (general pain)
Norco 5 mg / 325 mg every 4 hours as needed for severe pain
Tylenol 650mg every 8 hours scheduled, then as needed after stopping Norco
Tizanidine 4mg three times a day as needed for muscle spasms
For neuropathic pain (nerve pain)
Gabapentin 300mg TID scheduled or Lyrica 75 mg BID scheduled
Increase by 300mg every 3 days, max dose 1200mg TID
For example if you are taking 300 mg 3 times a day, first increase the evening dose to 600 mg, then 3 days later, increase the afternoon dose to 600 mg, etc.
Will switch to pregabalin if gabapentin not tolerated
When we make medication adjustments
If there is a prior history of pain medication use
If the pain from surgery is expected to high
If patient poorly tolerate certain medications
When pain management is not our responsibility
When surgery is removed from the schedule
When surgery is delayed for a long period of time
When the risk of the medication is felt to be too high
