NON-OPIOD ALTERNATIVES TO MANAGE POSTOPERATIVE PAIN
- Acetaminophen and ibuprofen work by different mechanisms, so when combined or alternated, they can produce additive or synergistic pain relief.
- Acetaminophen is also known as Tylenol. Ibuprofen is a generic medication. Many store brand versions of ibuprofen exist. Trade names include Advil, Motrin and Nuprin. All are acceptable options. Be aware that patients taking blood thinners (Coumadin, Plavix, Eliquis, etc.) may NOT take ibuprofen, only Tylenol.
- It is important to take ibuprofen and other NSAIDS (such as Aleve) with food. NSAID medications can exacerbate reflux or “Gerd”. If you have a history of gastrointestinal bleeding or have been told by your primary care physician to avoid non-steroidal, anti-inflammatory medications, please make your surgeon aware.
Option1 – Combined Dosing Every 6 Hours (simple and Effective)
Take both together every 6 hours:
- Acetaminophen: 500-650mg
- Ibuprofen: 200-400mg
Example:
- 8am-Both
- 2pm-Both
- 8pm-Both
- 2am-Both (if needed)
Why this works: Taking them together provides peak synergy and steady analgesia.
Option 2 – Alternating Every 3 Hours (More Frequent Coverage)
Alternate them so that medication is taken every 3 hours:
Example:
- 8:00am: Acetaminophen
- 11:00am: Ibuprofen
- 2:00pm: Acetaminophen
- 5:00pm: Ibuprofen
- 8:00pm: Acetaminophen
- 11:00pm: Ibuprofen
Why this works: Keeps blood levels of one analgesic active at all times.
Safe Daily Limits (VERY IMPORTANT)
Acetaminophen
- Max 3,000 mg/day for healthy adults
- Max 4,000 mg/day only under medical supervision
- Avoid alcohol; dangerous for the liver
Ibuprofen
- Over the counter max: 1,200 mg/day
- Prescription max (if directed by a clinician): 2,400-3,200 mg/day
- Take with food; risk of stomach irritation, ulcers, bleeding kidney stress
Which regimen is “best”?
For most healthy adults needing short term pain control, Option 1 (combined dosing) tends to give the strongest and simplest pain relief.
Option 2 is good if you want to avoid peaks/valleys in relief and cannot tolerate taking them together.
How long is it safe?
- Typically 1-3 days for acute pain (injury, dental procedure, headache, etc.)
- For more than 3 days, or if pain worsens, you should seek medical advice.