Editing Elmer Alternatives to Opioids for Analgesia

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space-References.Pharm.Elmer_Alternatives_to_Opioids_for_Analgesia"><p>&nbsp;</p><p><ins><strong>Dr. John Elmer alternatives to using narcotics post-op plan</strong></ins></p><ul><li>Standing 975g q6H APAP</li><li>Diclofenac topical 2gm QID (Voltaren gel) peri-incisional</li><li>Lidocaine patches peri-incisional (up to 3-4, more for larger patients)</li><li>Capsaicin&nbsp;</li><li>OOB TID, allow patient to go outside with nurse off the monitor&nbsp;</li></ul><p><ins>Escalate order</ins>:</p><ul><li>Ketamine drip&nbsp;</li><li>Toradol if 2-3 days post-op and no coagulopathic concerns</li><li>Oxy only after all of the above have failed&nbsp;</li></ul><p><ins>Adjunctive orders</ins>:</p><ul><li>Gabapentin / Lyrica for neuropathic pain&nbsp;</li></ul><p><ins>Other Elmer Pearls</ins>:</p><ul><li>Robaxin is useless for spasm and is just making your patient's fall asleep a little <ul><li>conflicting trials: <ul><li>1975 proving efficacy <span class="wikiexternallink"><a href="https://pubmed.ncbi.nlm.nih.gov/1102260/">A double-blind trial of methocarbamol versus placebo in painful muscle spasm - PubMed (nih.gov)</a></span></li><li>2018 study arguing against efficacy <span class="wikiexternallink"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820149/">A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain - PMC (nih.gov)</a></span>&nbsp;</li></ul></li></ul></li></ul></body>
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