Multi-modal Perioperative Pain Control

One of the biggest fears that the patient has about joint replacement is pain control. In the past, we simply gave narcotics but we have made great advancements recently in understanding and managing pain without relying on narcotics. We have demonstrated that by controlling various pain pathways (i.e., inflammation, central nerve sensitization, peripheral nerve irritation, and muscle spasm), we can safely manage pain after the surgery. My plan for the two weeks is as follows:

1.     Decadron (steroid) before and after the surgery

• Also helps with nausea

2.     Ice aggressively

• 20 min every 1 – 2 hrs

3.     Rest

• No need for aggressive movement in the first week

4.     Tylenol

• 3000 – 4000 mg a day for the first 2 weeks

5.     Anti-inflammatory meds

• Toradol (Ketorolac) in hospital / Mobic (Meloxicam) at home

6.     Nerve pain medication

• 100 mg Gabapentin in the morning/ 300 mg Gabapentin at bedtime (stop this medication if it makes you too dizzy or delirious)

7.     Muscle relaxant

• Flexeril 5 mg three times a day

8.     Narcotics as needed

• Tramadol 50 mg for moderate pain

• Oxycodone 5 mg for severe pain

*If you are 75 year old or older, I would not prescribe gabapentin or Flexeril as it can lead to delirium or risk of falling.