Table 2.
Perioperative medications.
| Medication | Dosing information |
|---|---|
| Preoperative | |
| Pantoprazole | 40 mg PO |
| Pregabalin (or gabapentin) | 150-300 mg PO (600-1200 mg PO) |
| Tranexamic acid | 1 g IV before incision and at wound closing |
| Continuous femoral nerve block (CFNB) | 20 mL bolus of 0.5% ropivacaine, infusion of 0.2% ropivacaine at pump settings 5/5/60/1a |
| IPACK for TKAs | 20 mL of 0.5% ropivacaine |
| Intraoperative | |
| CFNB | Infusion of 0.2% ropivacaine at pump settings 5/5/60/1a |
| Spinal anesthesia single shot | 10-15 mg bupivacaine |
| General anesthesia with propofol ± inhalation anesthetic agents | |
| Fentanyl | 50-100 mcg IV PRN |
| Dexamethasone | 8 mg IV |
| Acetaminophen | 1000 mg IV |
| Ketorolac | 15-30 mg IV |
| Ondansetron | 4-8 mg IV |
| Postoperative | |
| CFNB | Infusion of 0.2% ropivacaine at pump settings 5/5/60/1a |
| Aspirin | 81 mg BID PO for 6 weeks for VTE prophylaxis |
| Acetaminophen | 500-1000 mg PO TID as first-line analgesic |
| Ibuprofen, naproxen, or celecoxib | NSAID of patient’s choice for 2 weeks, if tolerated |
| Tramadol | 50-100 mg PO q8h PRN as first-line analgesic |
| Hydrocodone-acetaminophen, 5-325 mgb | 1-2 tabs PO q4-6h PRN as second-line analgesic |
| Oxycodone, 5 mgb | 1-2 tabs PO q4-6h PRN as second-line analgesic |
BID, twice a day; CFNB, continuous femoral nerve block; IPACK, Interspace between the Popliteal Artery and the Capsule of the posterior Knee; IV, intravenous; NSAID, nonsteroidal anti-inflammatory drug; PO, orally; PRN, as needed; TID, three times a day.
a
Settings for a pain pump device representing 5 mL/h of continuous infusion, 5 mL of a patient demand dose, 60-minute lockout, and one patient demand dose per lockout period.
b
Hydrocodone-acetaminophen was our preferred prescription, but if a patient had an allergy to or could not tolerate this medication, they were instead prescribed oxycodone.