Drug | Suggested dosing | Timing of administration | Comments |
Acetaminophen (paracetamol) | Oral: 325 to 1000 mg every 4 to 6 hours; maximum dose 4 g per day IV:
| Preoperative, intraoperative, and postoperative |
|
Nonsteroidal anti-inflammatory drugs (NSAIDs) | |||
Celecoxib | 200 to 400 mg orally preoperatively; 200 mg orally every 12 to 24 hours postoperatively | Preoperative*, intraoperative, and postoperative until hospital discharge |
|
Diclofenac | 50 mg orally every 6 to 12 hours, maximum 150 mg in 24 hours | ||
Ibuprofen | 600 to 800 mg orally or IV every 6 to 8 hours | ||
Ketoprofen | 50 to 75 mg orally every 6 to 8 hours | ||
Naproxen (base) | 500 mg orally every 12 hours | ||
Ketorolac¶ | Weight ≥50 kg and age <65 years: 15 to 30 mg IV every 6 to 8 hours Weight <50 kg or age ≥65 years: 15 mg IV every 6 to 8 hours | ||
MeloxicamΔ | 15 mg orally (conventional tablet) or 30 mg IV once per day | ||
Gabapentinoids | |||
Pregabalin | 75 to 150 mg orally once (preoperatively); 75 mg orally every 12 hours (postoperatively) | Preoperative, postoperative until hospital discharge for patients with moderate to severe pain |
|
Gabapentin | 300 to 600 mg orally every 8 hours | ||
Ketamine | Intraoperative: Bolus 0.25 to 0.5 mg/kg IV (maximum 35 mg) followed by an infusion of 0.1 to 0.5 mg/kg/hour (2 to 8 mcg/kg/minute) | Intraoperative; postoperative should be considered if local policy allows |
|
Lidocaine | Bolus: 1 mg/kg IBW IV near time of induction Infusion: 1 to 2 mg/kg IBW/hour intraoperatively | Intraoperative; postoperative may be considered if local policy allows and surgery is associated with high degree of inflammation (ie, abdominal surgery, breast, or spine surgery) |
|
Dexamethasone | 4 to 8 mg IV or orally every 8 hours | Preoperative, intraoperative, and postoperative |
|
Alpha-2-receptor agonists | |||
Clonidine | IV: 1 to 4 mcg/kg once Oral: 200 to 300 mcg once Transdermal patch: 0.2 mg/24 hours for patients receiving ketamine infusions for multiple days | Preoperative and postoperative |
|
Dexmedetomidine | Loading dose, if hemodynamically stable (may be omitted): ≤0.5 mcg/kg IV over 10 to 15 minutes Infusion: 0.3 to 0.7 mcg/kg/hour | Intraoperative and postoperative |
|
IBW: ideal body weight; IV: intravenous; US FDA: United States Food and Drug Administration; MI: myocardial infarction; COX-2: cyclooxygenase, isoform 2; PONV: postoperative nausea and vomiting; PACU: post anesthesia care unit; ICU: intensive care unit.
* For some surgical procedures, NSAIDs should not be administered until the surgeon confirms adequate intraoperative hemostasis.
¶ UpToDate contributors avoid ketorolac in patients with significant kidney impairment (ie, CrCl <60 mL/minutes) and those at increased risk for acute kidney injury.
Δ Due to its prolonged half-life (ie, ~24 hours) onset of full analgesic effect of meloxicam may be delayed relative to shorter-acting NSAIDs.Do you want to add Medilib to your home screen?