Ibuprofen & Percocet together?

[FemmeRN]

Hi all,

I'm a new nurse working on a mother/baby floor. Our standard orders for post partum patients include Ibuprofen 800mg Q6H and also Percocet 5/325 Q4H prn for pain >/= 5/10.

During my orientation, I've seen that some nurses will hold the Ibuprofen dose, if the pt recently (for example, within 30 minutes) got Percocet, and the pain is controlled, or give the Percocet instead of the Ibuprofen, if the pt is complaining of pain 8/10 at the time of the scheduled Ibuprofen dose.

My understanding is that the Ibuprofen is more to reduce inflammation (in addition to pain relief) and it should be kept "on board" around the clock to be most beneficial.

So, my question to all of you more experienced nurses...would you hold the Ibuprofen? Is there a clinical reason not to give them together? Or is it better to have a pt c/o 8/10 pain try the Ibuprofen at the scheduled time, and reassess in 30-60 min, and then give the Percocet, if the pain is still not controlled?

Thanks for your input. You all are such a wealth of knowledge!

[NursePaula]

I thought so! Like I said, long day though....thanks, Paula

[kstec, LPN]

ibuprofen / oxycodone - oral

[color=#006599]pronunciation: (eye-byou-pro-fen/ox

carefully consider the potential benefits and risks of combunox and other treatment options before deciding to use combunox. use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see warnings).

after observing the response to initial therapy with combunox, the dose and frequency should be adjusted to suit an individual patient's needs."

for the management of acute moderate to severe pain, the recommended dose of combunox is one tablet given orally.

dosage should not exceed 4 tablets in a 24-hour period and should not exceed 7 days.

[Elvish, BSN, DNP, RN, NP]

NursePaula said:

It's been a long day so excuse the stupid questions, but isn't 2400 mg the max dose for ibuprofen in 24 hours?.......

2400 for Ibuprofen, 4000 for APAP (unless liver issues, then would be less).

We give our 600 of Ibuprofen q6 ATC and Percocet 1-2 q4 prn.

[L&DRN03]

Both Ibuprofen and percocet are prescribed as prn medications in my unit so neither are given ATC. It would make sense to give one then reassess and see if a second pain med. is needed. No need to over medicate a mom if it is not needed.

[Jolie, BSN]

I have no problem giving both meds, at the same time if needed.

In my experience, they seem to be effective for different types of pain. Ibuprofen is excellent for controlling pain from uterine contractions, which seems to be "masked" somewhat by incisional pain in post-op C-section moms (meaning that they sometimes have a hard time recognizing afterbirth pains from operative pain.) Keeping up with ibuprofen around the clock often takes care of this and decreases the patient's need for narcotics.

Percocet seems to be most effective for perineal trauma (swelling, hematoma, laceration, episiotomy or repair) and for obvious operative pain.

Both my babies were delivered lady partslly, but I had extensive episiotomies with both, and ibuprofen just wasn't sufficient for the pain.

[Elvish, BSN, DNP, RN, NP]

I've also had patients tell me they liked their sitz bath way better than Percocet for their sore bottoms. Which I can completely understand and mind was only a 2nd degree tear.

[mjb324]

Absolutely!! We give motrin 600mg q6h and percocet 1-2 tabs q3hr prn. We have been doing a pain study over the last year and with this combo our pain satisfaction scores soared. Plus, on a personal level, this combo worked great for me after my c/s. I found I only required the percocet at night to help with sleep.

[SmilingBluEyes]

Elvish said:

I think it's perfectly appropriate to give ibu along with the percocet (1 or 2). It's been my experience that they work better together. No clinical reason not to. I've seen some people try to 'ration' Percocets which kind of annoys me. That's not really the point, as long as you're under the 4000mg APAP per 24 hrs.

If somebody's pain is 8/10, I'd be inclined to give them 2 percs and a motrin.

And I do the same. And for post ops or people with painful postpartum recoveries, they get these meds on a schedule, unless they request otherwise. We use naproxen most often----I give these every 8 and the Percoset every 4, ON SCHEDULE. I have found this makes for much better pain control overall.

The docs expect us to use both if people are in serious enough pain. And it is considered safe to do so.

I also use adjuct therapies, like ice for 1st 24 hours, heat after, position changes and warm showers---warm packs for severe cramps/post partum contractions. I encourage early ambulation as well. All these work as well, if not better, than narcotics to reduce pain in general, and it's good for their recovery.

[FemmeRN]

Thanks so much for all your replies!

NursePaula said:

It's been a long day so excuse the stupid questions, but isn't 2400 mg the max dose for ibuprofen in 24 hours?.......

My nurse's drug guide from school (Springhouse, 2006) says the max daily dose is 3200mg. We give 800mg Q6H, which hits that max. But most of our doctors send pts home with an Rx for the 2400mg you mentioned, either 800mg q8h, or 600mg q6h.

[ldcmw1]

I think this question is based on each individual pt. With a normal lady partsl delivery and no repair I think ibuprofen 600-800 mg works for most patients. If that doesn't do the trick then you can give percocet. If the person has an extensive repair then I give the ibuprofen and percocet.

For c/s we give 550 of anaprox and 2 percocet. Some doctors order toradol 30 mg im instead of anaprox which I like better. That way if they throw up in recovery they still have the toradol on board and 30 mg of toradol is like 10 mg of morphine but without all the respiratory side effects. We also give 10 mg of nubain in recovery for itching. That also helps with the post-op pain.

I also try and explain to my patient that it seems like I'm giving them a lot of pain medicine but the less pain they feel the more apt they are to start moving around faster. Which in turn helps promote healing, lessens the chance of developing dvt's, pulmonary edema and other post-op complications.