|
Multimodal Post-op Pain Management
decadron 6-8 mg iv prior to case
ketolac 30mg at end of case, then 30mg Q6 x 3 doses (consider intranasal toradol)
celebrex or mobic
intervenous tylenol
Prevent post op nasuea: zofran, scopoloamine patch
schedule hydrocondone or oxycodoone
Dilaudid IV rescue
Exparel injection
- 20cc Exparel (266 miligrams)
- 25cc 0.5% Marcaine (plain)
- 0.5mg 1/1000 epinephrine
- 30mg toradol
- mix in 60 cc syringe with saline to total 60cc
- inject using 20 or 21 gauge spinal needle
- Do not use toradol in renal impaired patients
- Current prospective, randomized controlled trials fail to support the routine use of liposomal bupivacaine compared with other local injectable analgesics, particularly in TKA. (Abildgaard AT, JBJS Reviews: July 2019 - Volume 7 - Issue 7 - p e8 doi: 10.2106/JBJS.RVW.18.00192)
Ketorolac
- Pre-op: 15-30mg IV
- Post-op: 15-30mg Q6hrs for 7 doses
- Contraindications: renal insufficiency
Ibuprofen
- Pre-op: 800mg PO
- Post-op: 800mg PO Q6hrs
- Contraindications: GERD/PUD
Celecoxib
- Pre-op: 400mg PO
- Post-op: 200mg PO Q12hrs
- Contraindications: sulfa allergy
Gabapentin
- Gabapentin does not reduce morphine consumption or opiod-related side affects following TKA. (Paul JE, JBJS 2013;95:2060)
- Pre-op: 300mg PO
- Post-op: 300mg PO Q12hrs
- Contraindications: renal insufficiency
Pregabalin
- Pre-op: 75mg PO
- Post-op: 75mg PO Q12hrs
- Perioperative use of pregabalin may decrease post-operative opioid consumption (Burke SM, Shorten GD. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy. Anesth Analg. 2010 Apr 1;110(4):1180-5)
- Contraindications:
Acetaminophen
- Pre-op: 1000mg IV
- Post-op: 650mg IV Qhrs
- Contraindications: liver disease
References
- Parvizi J, Orthopedics 2013;36:7-14
|