TCOmn.com Multi-modal Analgesia The key to multi-modal Analgesia is to use to several medications that act on different sites in the central and peripheral nervous system. The efficacy of the multi-modal approach is well established, however there is no consensus on what the optimum medication orders should be. Most common drugs used are NSAIDs, COX-2 inhibitors, gabapentin, acetaminophen, clonidine, and ketamine.
Preoperative Medication Pre-dosing the Total Joint Patient (30-60 minutes before surgery) Oxycontin mg PO once Vistaril mg PO once Tylenol 1000mg PO once Celebrex 400mg PO once Neurontin 300 mg PO once Scopolamine Patch 1.5 mg patch remove in 3 days.
TCOmn.com Intraoperative Medication Peripheral Nerve Blocks Dexamethasone 10 mg IV Tranexamic Acid 1 g at time of induction Acetaminophen 1000mg IV
TCOmn.com Postoperative Medication Dilaudid 2-4 mg PO Q 4 hours PRN Oxycodone 5-20 mg 1-2 tablets PO every 6 hours PRN pain Oxycontin mg PO BID PRN x 7 days Acetaminophen 650 mg PO Q 4-6 hours PRN Vistaril mg PO q 6 hours PRN Diazepam mg PO q HS Toradol mg IV every 6 hours. Discontinue after 24 hours.