Table 2.

Multimodal Analgesia Options

Medication/Technique	Timing	Dosage	Duration	Contraindications/Caution
Local and/or regional analgesia	Preoperatively or intraoperatively	Local anesthetic maximum dosage	Depends on local anesthetic used	Local anesthetic systemic toxicity
Acetaminophen	Preoperative dose or intraoperatively continued postoperatively	1000 mg preoperative// 1000 mg q6 hours postoperative	Continue until healing	Liver disease
NSAID	Intraoperatively continued postoperatively	Ketorolac 15–30 mg IV// Meloxicam 15 mg	Continue until healing	Cardiac or renal disease; caution in patients at risk for GI bleeding
Gabapentin	Preoperative and continued postoperatively	600 mg preoperative dose// 100–300 mg TID	Continue 5 days after surgery	Avoid in elderly, morbidly obese, obstructive sleep apnea, and patients requiring high opioid doses after surgery; caution in patients with renal impairment
Cyclobenzaprine	Postoperatively	5–10 mg TID PRN	Discontinue as soon as able	Caution in geriatric patients and in those requiring higher doses of opiates
Oxycodone	Postoperatively	5 mg q3-4h PRN	Discontinue as soon as able	Use only as rescue (breakthrough pain)

PRN: as needed; TID: three times daily.