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

2. 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.

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

5. 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.

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

7. 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.

8. Anticoagulation
Coumadin
Aspirin
Lovenox
Xarelto

9. Questions ??