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tively can help orthopedic patients decrease post-op pain and opioid consump-
tion. Researchers in one study found that patients who received 300 mg of prega-
balin before undergoing total hip arthroplasty had reduced pain and morphine
consumption in the first 24 hours after surgery. This was coupled with a multi-
modal plan that included 1 g of acetaminophen pre-operatively and post-opera-
tively, spinal anesthesia intraoperatively and morphine PCA post-operatively.
In addition to pain relief, these drugs have also shown signs of improving
movement following orthopedic surgery. In one randomized study, patients were
given 600 mg of gabapentin pre-operatively and 0 mg, 100 mg, 200 mg or 300 mg
of gabapentin post-operatively. They also were given celecoxib, femoral and sci-
atic nerve blocks, and spinal anesthesia. Researchers found that those given
gabapentin had improved knee flexion and decreased opioid consumption, com-
pared with those who didn't. Similar results were found in another study that
looked at patients undergoing ACL repairs.
For total joint repairs, ketamine has also been shown to be effective. When
patients received ketamine intraoperatively while undergoing total knee replace-
ment, researchers found they had decreased morphine consumption, decreased
pain scores at both rest and movement, and improved knee range of motion.
It should be noted that decreasing pain doesn't always mean increasing
dosage. In one study, patients undergoing lumbar discectomy were given 0 mg,
300 mg, 600 mg, 900 mg or 1,200 mg of gabapentin 2 hours before surgery.
Researchers found those who received less than 300 mg consumed more fen-
tanyl post-operatively than the other groups. However, those who received the
900 mg and 1,200 mg doses didn't consume fewer opioids than the 600 mg
group, but they did experience more side effects. This has led many facilities to
use 600 mg of gabapentin as an optimal pre-op dose for post-op pain relief.
3. Regional anesthesia is a great foundation
Regional anesthesia is an important element — if not the foundation — for
multimodal analgesia in orthopedic procedures. Since general anesthesia
