Orthopedic Pharmacology: What, When, How, Why and Why not? Justina Lehman-Lane, CNP, DNP

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.

Nonselective NSAIDs COX-2 Inhibitors Acetaminophen Pregabalin Opioids Peripheral Nerve Blocks

Preoperative Medication Pre-dosing the Total Joint Patient (30-60 minutes before surgery) Oxycontin 10-20 mg PO once Vistaril 25-50 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.

Intraoperative Medication Peripheral Nerve Blocks Dexamethasone 10 mg IV Tranexamic Acid 1 g at time of induction Acetaminophen 1000mg IV

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 10-20 mg PO BID PRN x 7 days Acetaminophen 650 mg PO Q 4-6 hours PRN Vistaril 25-50 mg PO q 6 hours PRN Diazepam 2.5-5 mg PO q HS Toradol 15-30 mg IV every 6 hours. Discontinue after 24 hours.

Anticoagulation Coumadin Aspirin Lovenox Xarelto

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