Pain Management
Multimodal analgesia protocols, PCA dosing, opioid equivalence calculator, and non-opioid adjunct reference.
Pre-Op
Gabapentin
300 mg|PO|Once, 1-2 hr before surgery
CI: Renal impairment, Elderly (reduce dose)
Celecoxib
400 mg|PO|Once, 1-2 hr before surgery
CI: Sulfonamide allergy, Renal impairment, GI bleeding
Acetaminophen
1 g|PO|Once, 1-2 hr before surgery
Max: 4 g/day (2 g if liver disease)
Intra-Op
Spinal / Femoral or Adductor Canal Block
Per protocol|Neuraxial / Perineural|Once
Ketamine
0.5 mg/kg|IV|Bolus at induction
Max: 50 mg bolus
Dexamethasone
8 mg|IV|Once
CI: Uncontrolled diabetes
Post-Op
Acetaminophen
1 g|PO/IV|q6h scheduled
Max: 4 g/day (2 g if liver disease)
NSAIDs (Ketorolac or Ibuprofen)
Ketorolac 15-30 mg IV or Ibuprofen 400 mg PO|IV/PO|q6h scheduled
Max: Ketorolac max 5 days
CI: Renal impairment, GI bleeding risk
Opioids PRN
Oxycodone 5-10 mg or Morphine 2-4 mg IV|PO/IV|PRN q3-4h
Cryotherapy / Physical Therapy
N/A|Topical / Activity|As tolerated, early mobilization
Clinical Notes
- Adductor canal block preferred over femoral nerve block for TKA — preserves quadriceps strength
- Consider periarticular injection by surgeon as alternative
- Gabapentin may cause sedation in elderly — consider reducing to 100-200 mg