Table 3.
Alternative MMA Options
| Medication/Technique | Alternatives | Dosage | Duration | Contraindications/Caution |
|---|---|---|---|---|
| Acetaminophen | None | 1000 mg q6h | Up to 7 days after surgery | Severe liver disease |
| Celecoxib | Ibuprofen | 600–800 mg q8h | Up to 7 days after surgery | Cardiac or renal disease; caution in patients at risk for GI bleeding |
| Ketorolac (IV) | Meloxicam (PO) | 15–30 mg, intraoperatively | Intraoperative | Same as celecoxib |
| Gabapentin | Pregabalin | 300–600 mg, q8h Pregabalin: 75 mg q12h |
Up to 5–7 days after surgery | Can cause somnolence; respiratory depression when combined with high dose opioids; requires dose adjustment in renal impairment |
| Cyclobenzaprine | Tizanidine | 2 mg q8h; increase by 2–4 mg to max dose 36 mg in 24 hours | Up to 5–7 days after surgery | Requires dose adjustment in renal impairment |
| Methocarbamol (PO) | 1000 mg q 6h | Continue 5 days after discharge if initiated inpatient | Requires dose adjustment in renal impairment | |
| Oxycodone | Hydrocodone | 5 mg q3-4h, PRN for breakthrough pain | Discontinue as soon as able | Contains acetaminophen—decrease other sources of acetaminophen |
| Morphine (PO) | 15–30 mg q3-4h PRN immediate release | Discontinue as soon as able | ||
| IV hydromorphone | Morphine (IV) | 2.5–5 mg q3-4h. PRN | Discontinue as soon as able | |
| Fentanyl (IV) | 50–100 mcg q1-2h PRN | Discontinue as soon as able |
CLD: clear liquid diet; PRN: as needed; TID: three times daily.