erated analgesic we have at our disposal. The majority of patients can
tolerate it, except perhaps individuals with advanced liver disease.
Used at appropriate doses as an around-the-clock pain-relieving drug,
it has been shown to markedly reduce opioid requirements.
Dr. Stamatos IV acetaminophen is just wonderful. It works as a great
adjunct medication and as a narcotic-sparing drug.
Dr. Viscusi Steroids are used commonly in the outpatient arena, but
might not be fully understood for what they do. Many anesthesia
providers give a healthy dose of dexamethasone (Decadron), which is
a wonderful antiemetic and anti-inflammatory agent that contributes
to better pain management.
Philip Wagner, MD We've found a very good pain management protocol
for hip and knee replacement patients that gets them out of bed the
next morning: a spinal or epidural anesthetic followed by a transition
to oral medications, which involves a combination of an anti-inflam-
matory adjunctive medication such as pregabalin (Lyrica) or
gabapentin (Neurontin) and some level of opioid medications for
patients who need stronger pain relief during the transition off the ini-
tial cocktail.
Dr. Viscusi Nonsteroidals and COX-2 inhibitors are anti-inflammatories
that work peripherally and centrally. The beauty of the peripheral
action is that it's very effective for dynamic or movement pain.
Dr. Stamatos Ketorolac tromethamine (Toradol) is still the mainstay of
IV nonsteroidal agents. It's been around for 15 years and is still very
effective. The initial studies when the drug first came out said a single
dose is equivalent to 3 mg of morphine for attacking bony pain. For an
anti-inflammatory to have that kind of pain-relieving potential is pretty
3 8
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | February 2015
