sound guided adductor canal peripheral nerve block with catheter
using 15-20 cc of 0.5% ropivacaine and 4 mg decadron. The patient can
still extend his leg and walk with an adductor canal nerve block so we
can get him ambulating sooner.
Intra-op: Spinal anesthetic for this case is preferred. Administer the ket-
amine, magnesium, and lidocaine infusion together to help with surgical
pain during and after the procedure for a narcotic sparing technique.
Post-op: Overall goal for pain management is to provide superior
analgesia without the need for narcotics. An adductor canal nerve
block catheter will keep them pain free for 3 days using a 0.2% ropiva-
caine infusion at 10-14 mL/hr. Depending on the patient's risk factors,
schedule gabapentin or Tylenol 3 times a day for post-op pain man-
agement. You can give 15-30 mg Toradol for any break through pain.
We can do a 2-hour knee replacement with no opioids using this
method.
Mr. Bland explains:
Pre-op: Give the
APAP IV with the
celecoxib and
gabapentin.
Intra-op: The surgeon
will initiate an
Exparel infiltration
and will inject the
encapsulated bupiva-
caine into the planes of the tissue. This is usually adequate to keep the
patient pain free through post-op for 3-days. If necessary, give keta-
9 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M a r c h 2 0 1 7
Robert Bland, CRNA
Pre-op:
• 1000 mg APAP IV
• 200 mg celecoxib
• 300-400 mg gabapentin
Intra-op:
• Exparel — encapsulated
bupivacaine (surgeon
administers at surgical site)
• Ketamine + decadron (optional)
• 2 mg of magnesium
sulfate (optional)
• 0.5% ropivacaine + 10mg
decadron (optional)
Post-op:
• 1000 mg APAP IV
• Oral APAP
• 15 mg ketorolac IV (optional)
• 0.5% ropivacaine + 10 mg
decadron (optional)
Total Knee Arthroplasty
