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.
5 Preoperative Medication Pre-dosing the Total Joint Patient (30-60 minutes before surgery)Oxycontin mg PO onceVistaril mg PO onceTylenol 1000mg PO onceCelebrex 400mg PO onceNeurontin 300 mg PO onceScopolamine Patch 1.5 mg patch remove in 3 days.
6 Intraoperative Medication Peripheral Nerve BlocksDexamethasone 10 mg IVTranexamic Acid 1 g at time of inductionAcetaminophen 1000mg IV
7 Postoperative Medication Dilaudid 2-4 mg PO Q 4 hours PRNOxycodone 5-20 mg 1-2 tablets PO every 6 hours PRN painOxycontin mg PO BID PRN x 7 daysAcetaminophen 650 mg PO Q 4-6 hours PRNVistaril mg PO q 6 hours PRNDiazepam mg PO q HSToradol mg IV every 6 hours. Discontinue after 24 hours.