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From a pain management perspective, codeine is an inferior analgesic; it just does not provide the same amount of pain relief even in equi-potent dosages as other oral medications such as oxycodone (the narcotic half of Percocet). It actually works better in kids and is one we frequently transition to in the pre-school through school-age population. Once we're dealing with teenagers, however, Percocet (oxycodone and acetaminophen) is a much better choice. I would never prescribe codeine/acetaminophen (Tylenol #3) to an adult for post-surgical pain.
At my previous institution, we typically did post-op epidural infusions with bupivacaine and fentanyl, which usually worked well. Once that was d/c'd after about 18-24 hrs, moms would get ketorolac (strong IV NSAID) or ibuprofen, along with percocets. When they needed stronger narcotics or were not tolerating po, they could receive IV morphine.
I bet the moms who receive Dilaudid (hydromorphone) IV for post-op pain are pretty happy.... :)
Sarah Reece-Stremtan M.D.
Pediatric anesthesiology fellow in Washington DC
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