Transcript Orthopedic Pharmacology: What, When, How, Why and Why not

Orthopedic
Pharmacology: What,
When, How, Why and
Why not?
Justina Lehman-Lane, CNP, DNP
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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.
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Nonselective NSAIDs
COX-2 Inhibitors
Acetaminophen
Pregabalin
Opioids
Peripheral Nerve Blocks
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Preoperative Medication
• Pre-dosing the Total Joint Patient (30-60 minutes
before surgery)
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Oxycontin 10-20 mg PO once
Vistaril 25-50 mg PO once
Tylenol 1000mg PO once
Celebrex 400mg PO once
Neurontin 300 mg PO once
Scopolamine Patch 1.5 mg patch remove in 3 days.
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Intraoperative Medication
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Peripheral Nerve Blocks
Dexamethasone 10 mg IV
Tranexamic Acid 1 g at time of induction
Acetaminophen 1000mg IV
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Postoperative Medication
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Dilaudid 2-4 mg PO Q 4 hours PRN
Oxycodone 5-20 mg 1-2 tablets PO every 6 hours PRN pain
Oxycontin 10-20 mg PO BID PRN x 7 days
Acetaminophen 650 mg PO Q 4-6 hours PRN
Vistaril 25-50 mg PO q 6 hours PRN
• Diazepam 2.5-5 mg PO q HS
• Toradol 15-30 mg IV every 6 hours. Discontinue after 24 hours.
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Anticoagulation
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Coumadin
Aspirin
Lovenox
Xarelto
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Questions ??
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