A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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A10 Bariatric Times [MAY 2014, SUPPLEMENT A] HOT TOPICS IN SURGICAL PAIN MANAGEMENT WARNING: RISK OF MEDICATION ERRORS AND HEPATOTOXICITY Take care when prescribing, preparing, and administering OFIRMEV injection to avoid dosing errors which could result in accidental overdose and death. OFIRMEV contains acetaminophen. Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed the recommended maximum daily limits, and often involve more than one acetaminophen-containing product. • OFIRMEV is contraindicated in patients with severe hepatic impairment, severe active liver disease or with known hypersensitivity to acetaminophen or to any of the excipients in the formulation. • Acetaminophen should be used with caution in patients with the following conditions: hepatic impairment or active hepatic disease, alcoholism, chronic malnutrition, severe hypovolemia, or severe renal impairment. • Rarely, acetaminophen may cause serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. • Discontinue OFIRMEV immediately if symptoms associated with allergy or hypersensitivity occur, or at the first appearance of skin rash. Do not use in patients with acetaminophen allergy. • The most common adverse reactions in patients treated with OFIRMEV were nausea, vomiting, headache, and insomnia in adult patients and nausea, vomiting, constipation, pruritus, agitation, and atelectasis in pediatric patients. • The antipyretic effects of OFIRMEV may mask fever in patients treated with postsurgical pain. • OFIRMEV is approved for use in patients ≥2 years of age. • Do not exceed the recommended maximum daily dose of OFIRMEV. • OFIRMEV should be administered only as a 15-minute infusion. IMPORTANT SAFETY INFORMATION hypertension, and OSA. He was scheduled for laparoscopic Roux-en-Y gastric bypass surgery. Previous c linical trials in our institution utilized a multimodal pain management and narcotic-free total intravenous anesthesia plan. In this multimodal analgesic approach, the first dose of OFIRMEV was given intraoperatively and continued every six hours until the morning of the first p ostoperative day with 3 to 4 doses given in the first 24 hours. Further analgesic medication included intraoperative ketamine, dexmedetomidine, and perioperative ketorolac. The patient received 2mg hydromorphone in the first 24 hours and two doses of 10mL hydrocodone/acetaminophen elixir 10/650 on postoperative day 2. Upon admission to the hospital, the patient stated his "acceptable" pain score was 4/10. During the first 48 hours, he complained once of having "unacceptable" pain and the median pain score was 2 in the first 48 hours. In terms of ambulation, he was mobilized the evening of the surgery and walked twice approximately 30 yards. The next day the distance was advanced to 100 yards several times during the day. In terms of diet, the patient started drinking clear, non- carbonated, sugar-free liquids on the first day. On p ostoperative day 2, the diet was advanced to protein shakes. The hospital course was uneventful and the patient was discharged on postoperative day 3. His two- week and four-week follow-up visits with the bariatric surgeon were normal for this type of procedure and his f urther recovery was uneventful. NOTE: These case studies are intended only to provide healthcare professionals with examples of the use of OFIRMEV (acetaminophen) injection in the treatment of the specific patients. The outcomes described may not be representative of, and may differ significantly from, outcomes that may be obtained in treating other patients. These case studies are not intended to provide specific treatment advice, recommendations, or opinions, and should not replace a clinician's judgment with respect to the treatment of any particular patient EDITED-Cadence Ofirmez Suppl copy 2_Layout 1 4/14/14 10:14 AM Page A10