Multimodal pharmacology for total joints.

[sevoflurane]

Anyone using gabapentin, celebrex or other pain modulators as routine PO meds the morning of surgery for patients undergoing total joints or other ortho procedures?

Just wondering how popular it is or is not despite Dr. Reube's fragulant studies.

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[pgg]

As a CA1 & 2, our TKA protocol was a femoral nerve catheter, spinal with morphine, postop PCA, monitored bed overnight (fear of PCA + intrathecal morphine). Carrying the pain service pager on call was torture. We were always getting called on them. Every time that pager went off an hour of my life was lost.

Around the beginning of my CA3 year, the TKA protocol changed to
- preop scopalamine patch
- preop Celebrex 200
- preop Neurontin 600
- preop Tylenol 1000
- femoral nerve catheter preop bolus of ~20 cc 0.5% ropiv
- spinal with morphine
- postop PCA (but rarely used by patient)
- PCA dc'd POD1, percocet started
- CFNC ran 0.2% ropiv until removal on AM of POD2
Difference was night and day ... can count on one hand the number of pain calls I got to postop TKAs while a CA3.

 

[IN2B8R]

Anyone using gabapentin, celebrex or other pain modulators as routine PO meds the morning of surgery for patients undergoing total joints or other ortho procedures?

Just wondering how popular it is or is not despite Dr. Reube's fragulant studies.

Most of the guys around here have given up that practice.

 

[Fastrach]

Anyone using gabapentin, celebrex or other pain modulators as routine PO meds the morning of surgery for patients undergoing total joints or other ortho procedures?

Just wondering how popular it is or is not despite Dr. Reube's fragulant studies.

For TKA's, we've gone almost exclusively to surgical epidurals. If pt declines epidural, will offer postop fem cathether or single shot fem block. Makes life pretty easy for everyone. Pull out catheter and transition to PO meds next morning.

 

[amyl]

nope. pts get FNC w 0.1% ropi and spinal w bupi 13.5mg w 25mcg fentanyl... some staff add 200mcg of epi depending on surgeon . FNC put on hold on POD2 after second round of PT. pain pager mostly quiet for peripheral nerve catheters but goes off once in a while pts are in pacu after spinal wears off. usually a mepivicaine bolus does the trick to get on top of tkr pain

we are in the middle of a study using intrathecal ketorolac to address the chronic pain assoc w total hips -- but no results yet.