Jeff Gadsden, MD

Jeff Gadsden, MD
 

Associate Professor
Duke University School of Medicine
Chief, Division of Orthopaedic, Plastic and Regional Anesthesiology
Duke University Medical Center
Chapel Hill, North Carolina


What are the advantages and disadvantages of using IV opioids as monotherapy outside the context of multimodal therapy, where other agents are used in conjunction as part of ERAS?

What are the advantages and disadvantages of using IV opioids as monotherapy outside the context of multimodal therapy, where other agents are used in conjunction as part of ERAS? What are the downsides of this approach?

What is the concept of ERAS and how does it affect your selection of pain-relieving agents and strategies, including multimodal approaches, in the perioperative setting?

What is the concept of ERAS and how does it affect your selection of pain-relieving agents and strategies, including multimodal approaches, in the perioperative setting?

What are the mechanisms of action by which IV acetaminophen exerts pain-relieving properties and how is it different from other agents? Why is this MOA suited for multimodal therapy?

What are the mechanism(s) of action by which IV acetaminophen exerts its pain-relieving properties and how is this differentiated from other agents? Why is this MOA particularly valuable and complementary as part of multimodal therapy ...

Given that IV opioids inhibit peristalsis and GI absorption and potentially affect PK/PD and C-max/T-max profiles of oral acetaminophen, what is the rationale for using IV acetaminophen?

Given that IV opioids are known to inhibit peristalsis and GI absorption and potentially affect PK/PD and C-max/T-max profiles of oral acetaminophen and other agents, what is the rationale and what is the literature support for using the ...

What is the optimal dosing strategy for deploying IV acetaminophen and how should it be combined with IV or opioid therapy? What is the role of this approach in the ambulatory surgery unit?

From a practical perspective, what is the optimal dosing strategy for deploying IV acetaminophen and how should it be combined with IV or opioid therapy? What is the role of this approach in the ambulatory surgery unit? And in what types ...

What dosing schedule do you recommend for acetaminophen? Why do you feel that IV acetaminophen is preferable to oral and what is the effect of IV opioids on absorption and blood levels?

What is the exact dosing schedule you recommend and use for acetaminophen? Why do you feel that IV acetaminophen is preferable to the oral formulation and what is the effect of IV opioids on absorption and blood levels or oral acetaminophen? ...

In what specific surgical procedures is IV acetaminophen indicated as a core agent in the context of multimodal management and ERAS? And what are the indications for this agent?

In what specific surgical procedures — from orthopedics to colorectal surgery — is IV acetaminophen indicated as a core agent in the context of multimodal management and ERAS? And what are the indications for this agent?

Can you compare and contrast the efficacy and safety of IV acetaminophen with the other IV non-opioid agents that are sometimes used in conjunction with IV opioids?

Can you compare and contrast the efficacy and, especially, the safety of IV acetaminophen with the other IV non-opioid agents that are sometimes used in conjunction with IV opioids? Why do you consider acetaminophen the “backbone” of multimodal analgesia?

If you have a surgical patient who is on both IV acetaminophen and an IV opioid and the patient becomes intolerant to the opioid, can you continue the IV acetaminophen alone as monotherapy?

If you have a surgical patient who is on both IV acetaminophen and an IV opioid and the patient becomes intolerant to the opioid, can you continue the IV acetaminophen alone as monotherapy and/or what other non-opioid might you add to achieve synergies?

What are the implications of IV acetaminophen having 100% bioavailability versus the oral formulation which undergoes first pass hepatic metabolism?

What are the implications of IV acetaminophen having 100% bioavailability versus the oral formulation which undergoes first pass hepatic metabolism? How does this affect C-max and what are the clinical implications?

What do T-max-focused studies show about the advantages of the IV route of administration of acetaminophen over oral and other formulations?

What do T-max-focused studies show about the advantages of the IV route of administration of acetaminophen over oral and other formulations?

Since a significant effect of acetaminophen is on central CNS receptors, what do studies measuring CSF levels show regarding IV administration of acetaminophen?

Since a significant effect of acetaminophen is on central CNS receptors, what do studies measuring CSF levels show regarding IV administration of acetaminophen? What do AUC results show and what is the significance of these findings clinically?

What are the effects of IV opioids on gastric emptying, transit, and GI absorption of IV acetaminophen versus oral acetaminophen?

What are the effects of IV opioids on gastric emptying, transit, and GI absorption of IV acetaminophen versus oral acetaminophen? What is the clinical and PK impact of giving concomitant opioids on these two routes of acetaminophen administration?

What did the TKR orthopedic study by Sinatra and colleagues show about the pain relieving properties of IV acetaminophen (four doses) and its effect on rescue opioid use and reduction of total morphine usage?

What did the TKR orthopedic study by Sinatra and colleagues show about the pain relieving properties of IV acetaminophen (four doses) and its effect on rescue opioid use and reduction of total morphine usage?