tion with a regional analgesia
option such as an adductor canal
or iPACK block.
• Intraoperatively.
Acetaminophen 1 gm IV (if not
given orally in the preoperative
period) and ketorolac 15 to 30 mg
IV (if celecoxib is not given preop-
eratively) if there are no con-
traindications. A regional analgesia
option includes surgical site infil-
tration.
• Postoperatively.
Acetaminophen 1 gm PO/q 6h +
celecoxib 200 mg PO/q12h or
meloxicam 15 mg PO once a day
(or any other NSAID of choice).
Oxycodone as needed for break-
through pain.
Dr. Joshi says acetaminophen and a non-steroidal anti-inflammatory
drug (NSAID) or a COX-2 specific inhibitor should be administered
unless there are contraindications, and they must be given round the
clock as scheduled dosing.
The guiding principle of your multimodal regimen should be that the
medications are acting at different sites in the central and peripheral
nervous systems. This creates a synergistic effect on pain control
while minimizing the side effects associated with any individual agent,
says Dr. Soffin.
Her standard multimodal pain management regimen includes local
anesthetic-based techniques (peripheral nerve blocks and catheters),
1 6 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 2 0
TAKING A SHOT Infiltrations of anesthetics at the surgical
site add another layer to multimodal pain regimens.
