| Preoperative holding |
- Acetaminophen: 1000 mg PO
- Celecoxib:
- Only order for patients with GFR >50 mL/minute
- Patients 18 to 64 years old: 400 mg PO
- Patients ≥65 years old: 200 mg PO
- ± Oxycodone (IR): 5 to 10 mg orally (consider for patients who have short-acting spinal or general anesthesia)
- Peripheral nerve block:
- Primary TKA: AC
- Revision TKA: AC or femoral
|
| Intraoperative |
- Preferred spinal anesthetic with low dose sedation (propofol <100 mcg/kg/minute)
- Dexamethasone: 8 mg IV
- Granisetron: 1 mg IV or Ondansetron: 4 mg IV, ± droperidol: 0.625 mg IV
- As necessary analgesia:
- Fentanyl <250 mcg IV ± hydromorphone <1 mg IV
- Consider ketamine 10 to 40 mg IV in divided doses; reduce to 5 to 20 mg IV for patients >75 years of age
|
| PACU |
- Fentanyl: 25 mcg IV as necessary or Hydromorphone: 0.2 mg IV as necessary for pain ≥4
- Acetaminophen: 1000 mg orally or IV (if last dose ≥6 hours)
- Ketamine: 10 mg IV once as necessary for pain ≥4
- Oxycodone (IR): 5 mg orally for pain ≤4 or 10 mg orally for pain ≥5 (1 dose prior to discharge)
|
| Floor care |
- Acetaminophen: 1000 mg PO every 6 hours (650 mg for age >75)
- Ketorolac: 15 mg IV every 6 hours for 4 doses (if GFR >50 mL/minute)
- Tramadol: 50 to 100 mg PO or Oxycodone: 5 to 10 mg PO or Hydromorphone: 2 to 4 mg PO (as necessary for pain)
- Fentanyl: 25 mcg IV as necessary for breakthrough pain ≥7; up to 3 doses
|
