Recently we have gone to a new regimen of pain control for Joint Replacement surgery.
We use pre-operative medications including 1 gram of Tylenol, 600 mg of gabapentin and 400 mg of celebrex to prepare the patient for surgery.
Intra-operative medications include lidocaine and ketamine to block the nMDA cell receptor and decrease the need for postoperative narcotics.
When ever possible we use regional anesthesia such as interscalene blocks for shoulder replacement, femoral nerve blocks for knee replacement, and spinal blocks for hip and knee replacement.
After the procedure is completed and before the soft tissue closure, a mixture of bupivicaine, dexamethasone, toradol and morphine is injected into the surrounding tissue, to prevent local pain and swelling and lasts for the first 48 hrs after the procedure.
For the length of the hospitalization, 1 gm of Tylenol is given every 8 hrs, along with gabapentin twice daily, celebrex 200 mg twice daily with a small dose of IV dilaudid available for breakthrough pain.
Upon discharge the patient continues the Tylenol, celebrex and gabapentin, and has an oral form of narcotic for breakthrough pain.
We have decreased the overall narcotic use in total hip surgery by 80% without changing the pain scores. Likewise total knee replacement patients have required 60% less narcotic without changing the pain scores.
Many patients are able to complete the peri-operative course without any narcotic whatsoever.
This significantly limits the amount of adverse complications from narcotic use such as confusion, constipation, fall risk and addiction.