Could pain from a shoulder surgery be triggering the Atrial Fibrillation ?
Patient: Have been taking 150mg propafenone hydrocloride twice a day for 18 months to control Atrial Fibrillation with good results however last three days AF has returned and the medication has not helped...I have had shoulder surgery 17days ago still in considerable pain could this be triggering it off despite my taking my pills...3 days ago took extra strength panadine (codeine and paracetamol) 8 tabs/24hrs..could this have interfered with my AF medication...my doctor is away this weekadvise will be greatly appreciated. Thank You, Buddy Lorenand Doctor: Yes , The pain activates the body sympathetic system 2hich pushes more adrenaline , cortisol like hormones in the circulation . This would act as a trigger for precipitating atrial fibrillation . As long codeine can cause change in the absorption of propafenone and make it less effective.  Codeine is available in different strengths and so I am not able to deduce the total quantity you too in a day , 3p mg every 4 hours is maximum you may take and never more than 360 mg of codeine in a day ( However this is maximum dose and you may have side effects far early withen the prescribed dose ) . Do consult your orthopedic doctor as such severe pain so many days after the operation is a worry and any reversible cause should be sorted out rather than just popping pills. Regards